Doctor Name: | MS. SUSAN DENISE BREWER |
NPI Number: | 1023491461 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.S., M.S.C.P., LPC |
License Number: | 4031 |
Business Practice Address: | 1504 Barksdale Blvd Bossier City, LA - 711114602 |
Business Phone Number: | 3182224299 |
Business Fax Number: | 3184252696 |
Mailing Address: | 1504 Barksdale Blvd, BOSSIER CITY |
State: | LA |
Postal Code: | 711114602 |
Phone Number: | 3182224299 |
Fax Number: | 3184252696 |
NPI Enumeration Date: | 07/02/2015 |
NPI Last Update Date: | 07/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4031 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |