| Doctor Name: | BRENDA JOAN BRANNON |
| NPI Number: | 1154615086 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPTA |
| License Number: | 20558960 |
| Business Practice Address: | 116 Dogwood Dr Winnfield, LA - 714835000 |
| Business Phone Number: | 4095944912 |
| Business Fax Number: | 4095944912 |
| Mailing Address: | 116 Dogwood Dr, WINNFIELD |
| State: | LA |
| Postal Code: | 714835000 |
| Phone Number: | 4095944912 |
| Fax Number: | 4095944912 |
| NPI Enumeration Date: | 06/08/2011 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | 20558960 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |