Provider Demographics
NPI:1376898957
Name:CAPDEBOSCQ, BROOKE RENEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:RENEE
Last Name:CAPDEBOSCQ
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 1:111 RAIFORD OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9571
Mailing Address - Country:US
Mailing Address - Phone:985-231-8230
Mailing Address - Fax:
Practice Address - Street 1:111 RAIFORD OAKS BLVD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9571
Practice Address - Country:US
Practice Address - Phone:985-231-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional