Provider Demographics
NPI:1598295487
Name:BRYANT, LAURA FAUTHEREE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:FAUTHEREE
Last Name:BRYANT
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 1:2717 INDIAN MOUND BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2353
Mailing Address - Country:US
Mailing Address - Phone:318-348-5601
Mailing Address - Fax:
Practice Address - Street 1:506 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280
Practice Address - Country:US
Practice Address - Phone:318-598-5040
Practice Address - Fax:844-270-1958
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health