Individual
BRANDON HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4650 LAKESHORE DR APT 119, SHREVEPORT, LA 71109-2950
(318) 834-5438
Mailing address
4650 LAKESHORE DR, APT 119, SHREVEPORT, LA 71109-2925
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009026727
—
LA
Enumeration date
03/23/2016
Last updated
03/23/2016
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