Provider Demographics
NPI:1518619022
Name:KOHN, BRANDIE TERO (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:TERO
Last Name:KOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MARYLAND AVE OFC B
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3966
Mailing Address - Country:US
Mailing Address - Phone:601-395-3616
Mailing Address - Fax:
Practice Address - Street 1:411 MARYLAND AVE OFC B
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3966
Practice Address - Country:US
Practice Address - Phone:601-395-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC92571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical