Provider Demographics
NPI:1912668757
Name:TROTTER, BRAIN C
Entity Type:Individual
Prefix:MR
First Name:BRAIN
Middle Name:C
Last Name:TROTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RIDGELAKE DR STE 309B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4938
Mailing Address - Country:US
Mailing Address - Phone:504-309-0259
Mailing Address - Fax:504-309-2702
Practice Address - Street 1:3100 RIDGELAKE DR STE 309B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4938
Practice Address - Country:US
Practice Address - Phone:504-309-0259
Practice Address - Fax:504-309-2702
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1750754727Medicaid