Provider Demographics
NPI:1841227212
Name:BRASHER, MAR-LOU (LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MAR-LOU
Middle Name:
Last Name:BRASHER
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE B-230
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-220-7401
Mailing Address - Fax:318-220-7404
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE B-230
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-220-7401
Practice Address - Fax:318-220-7404
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28461041C0700X
LA921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21615OtherBCBS PROVIDER NUMBER
LA5S957Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER