Provider Demographics
NPI:1578057139
Name:BREAUX, MICHELLE LYNN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BREAUX
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 1:655 BAYOU BLUE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-4115
Mailing Address - Country:US
Mailing Address - Phone:985-209-8809
Mailing Address - Fax:
Practice Address - Street 1:420 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6304
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:985-879-3966
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator