Individual
AMANDA FAYE BRUYNINCKX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
53 POWELL RD, OTIS, LA 71466-9758
(318) 753-5069
Mailing address
53 POWELL RD, OTIS, LA 71466-9758
(318) 753-5069
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
16819
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/26/2024
Last updated
08/28/2024
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