Provider Demographics
NPI:1306395496
Name:BRISCOE, DELORES A
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:A
Last Name:BRISCOE
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 1:623 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2115
Mailing Address - Country:US
Mailing Address - Phone:504-533-9885
Mailing Address - Fax:504-336-3180
Practice Address - Street 1:623 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2115
Practice Address - Country:US
Practice Address - Phone:504-533-9885
Practice Address - Fax:504-336-3180
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC6556101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health