Provider Demographics
NPI:1417429473
Name:HARRIS, BRENNEN SR
Entity Type:Individual
Prefix:MR
First Name:BRENNEN
Middle Name:
Last Name:HARRIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 PARLANGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2565
Mailing Address - Country:US
Mailing Address - Phone:504-231-9925
Mailing Address - Fax:
Practice Address - Street 1:13001 PARLANGE CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-2565
Practice Address - Country:US
Practice Address - Phone:504-231-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health