Basic Information
| Provider Information | |||||||||
| NPI: | 1750737698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREWTON | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | PAGE | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2453 | ||||||||
| Address2: | |||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714572453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182144002 | ||||||||
| FaxNumber: | 3182144004 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 4TH ST | ||||||||
| Address2: | |||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714574569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182144002 | ||||||||
| FaxNumber: | 3182144004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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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 | 1561 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.