Provider Demographics
NPI:1831740323
Name:BRINER, SHANON
Entity type:Individual
Prefix:
First Name:SHANON
Middle Name:
Last Name:BRINER
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 1:401 WILLOWDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-3053
Mailing Address - Country:US
Mailing Address - Phone:504-236-8775
Mailing Address - Fax:
Practice Address - Street 1:701 PAPWORTH AVE STE 209
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4923
Practice Address - Country:US
Practice Address - Phone:504-236-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor