Provider Demographics
NPI:1790246080
Name:BROWN, SHAURONA TELISSA
Entity Type:Individual
Prefix:
First Name:SHAURONA
Middle Name:TELISSA
Last Name:BROWN
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 1:7102 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-4747
Mailing Address - Country:US
Mailing Address - Phone:225-803-3600
Mailing Address - Fax:
Practice Address - Street 1:11445 REIGER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4556
Practice Address - Country:US
Practice Address - Phone:225-932-9867
Practice Address - Fax:225-932-9870
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor