Provider Demographics
NPI:1144753708
Name:BRANTLEY, LAVERNE SENORA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:SENORA
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4512
Mailing Address - Country:US
Mailing Address - Phone:318-636-4194
Mailing Address - Fax:318-636-4196
Practice Address - Street 1:3510 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4512
Practice Address - Country:US
Practice Address - Phone:318-636-4194
Practice Address - Fax:318-636-4196
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6599101YP2500X
LAPLC6599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional