Provider Demographics
NPI:1750751897
Name:MCDANIEL, BRENDA (MED)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCDANIEL
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 1:908 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5844
Mailing Address - Country:US
Mailing Address - Phone:318-325-8748
Mailing Address - Fax:
Practice Address - Street 1:908 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5844
Practice Address - Country:US
Practice Address - Phone:318-325-8748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7281104100000X
171M00000X
LAPLC6110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPLC6110OtherLPC BOARD OF EXAMINERS
LA7281OtherLABSWE