Provider Demographics
NPI:1275287955
Name:HEBERT, BRIONNE
Entity Type:Individual
Prefix:
First Name:BRIONNE
Middle Name:
Last Name:HEBERT
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 1:2229 N SAVANNAH LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3926
Mailing Address - Country:US
Mailing Address - Phone:337-842-8590
Mailing Address - Fax:
Practice Address - Street 1:119 WILLIAMSBURG ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5723
Practice Address - Country:US
Practice Address - Phone:337-376-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst