Provider Demographics
NPI:1205066479
Name:BRUNE, LISA JEAN (MSSW LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:BRUNE
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2533
Mailing Address - Country:US
Mailing Address - Phone:337-284-9779
Mailing Address - Fax:337-282-7967
Practice Address - Street 1:4016 HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2533
Practice Address - Country:US
Practice Address - Phone:337-284-9779
Practice Address - Fax:337-282-7967
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW # 309981041C0700X
LALCSW BACS #107551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical