Provider Demographics
NPI:1710666011
Name:KENNEY, BRIE C (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:BRIE
Middle Name:C
Last Name:KENNEY
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RUE JEAN LAFITTE STE 108
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3141
Mailing Address - Country:US
Mailing Address - Phone:337-210-5342
Mailing Address - Fax:
Practice Address - Street 1:111 RUE JEAN LAFITTE STE 108
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3141
Practice Address - Country:US
Practice Address - Phone:337-210-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5475101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)