Provider Demographics
NPI:1255863106
Name:BREAUX, ANIKA (MED)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HEYMANN BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2465
Mailing Address - Country:US
Mailing Address - Phone:337-446-4707
Mailing Address - Fax:337-446-4715
Practice Address - Street 1:322 HEYMANN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2465
Practice Address - Country:US
Practice Address - Phone:337-446-4707
Practice Address - Fax:337-446-4715
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor