Provider Demographics
NPI:1124390919
Name:BRAZZEL, LISA RENEE (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:BRAZZEL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MORNING MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6138
Mailing Address - Country:US
Mailing Address - Phone:318-557-5612
Mailing Address - Fax:
Practice Address - Street 1:106 MORNING MEADOW CIR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6138
Practice Address - Country:US
Practice Address - Phone:318-557-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2535101YP2500X
LA585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist