Basic Information
| Provider Information | |||||||||
| NPI: | 1447595558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRAS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CI, CIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 CANE BREAK DR | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703013977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257761925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5593 HIGHWAY 311 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703602866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CIT 3212 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | CI 5266 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.