Provider Demographics
NPI:1811561673
Name:BRUMANT, MACKISHA
Entity Type:Individual
Prefix:
First Name:MACKISHA
Middle Name:
Last Name:BRUMANT
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 1:400 JOHN WESLEY BLVD APT 172
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2294
Mailing Address - Country:US
Mailing Address - Phone:318-243-0622
Mailing Address - Fax:
Practice Address - Street 1:400 JOHN WESLEY BLVD APT 172
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2294
Practice Address - Country:US
Practice Address - Phone:318-243-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker