Provider Demographics
NPI:1023312816
Name:DEROUEN, BROOKE V (MA, LAC, LPC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:V
Last Name:DEROUEN
Suffix:
Gender:F
Credentials:MA, LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:
Practice Address - Street 1:500 RODERICK ST
Practice Address - Street 2:SUITE B
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-2247
Practice Address - Country:US
Practice Address - Phone:985-380-2460
Practice Address - Fax:985-380-2476
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1462101YA0400X
LA6278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)