Provider Demographics
NPI:1174047914
Name:BRACKETT, HADEN ANNA NOELLE
Entity type:Individual
Prefix:
First Name:HADEN
Middle Name:ANNA NOELLE
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62099 STRAHAN RD
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-5145
Mailing Address - Country:US
Mailing Address - Phone:618-421-5336
Mailing Address - Fax:
Practice Address - Street 1:328 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2710
Practice Address - Country:US
Practice Address - Phone:985-606-5070
Practice Address - Fax:985-606-5071
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty