Provider Demographics
NPI:1295105419
Name:BROWN, NEISHATAKA
Entity type:Individual
Prefix:
First Name:NEISHATAKA
Middle Name:
Last Name:BROWN
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 1:314 SE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71073-2550
Mailing Address - Country:US
Mailing Address - Phone:318-210-5856
Mailing Address - Fax:
Practice Address - Street 1:314 SE 5TH AVE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2550
Practice Address - Country:US
Practice Address - Phone:318-210-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health