Provider Demographics
NPI:1811401839
Name:FONTENOT MINKS, BROOKS ELIZABETH (BA)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:ELIZABETH
Last Name:FONTENOT MINKS
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12628 HOOPER RD STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3527
Mailing Address - Country:US
Mailing Address - Phone:225-953-8170
Mailing Address - Fax:225-342-5568
Practice Address - Street 1:12628 HOOPER RD STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3527
Practice Address - Country:US
Practice Address - Phone:225-480-6605
Practice Address - Fax:225-342-6207
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1215365689Medicaid
LA1881138899Medicaid