Doctor Name: | MR. MICHAEL ANTHONY BREAUX |
NPI Number: | 1447596457 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 10225 |
Business Practice Address: | 1585 3rd St Office 6065 Fort Polk, LA - 714595102 |
Business Phone Number: | 3375312113 |
Business Fax Number: | 3375313025 |
Mailing Address: | 1585 3rd St, Office 6065 FORT POLK |
State: | LA |
Postal Code: | 714595102 |
Phone Number: | 3375312113 |
Fax Number: | 3375313025 |
NPI Enumeration Date: | 12/19/2012 |
NPI Last Update Date: | 12/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 10225 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |