Basic Information
| Provider Information | |||||||||
| NPI: | 1174053995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | KINNEY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4103 LAC COUTURE DR | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043689935 | ||||||||
| FaxNumber: | 5043689918 | ||||||||
| Practice Location | |||||||||
| Address1: | 4103 LAC COUTURE DR | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043689935 | ||||||||
| FaxNumber: | 5043689918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 02/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11193 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.