Individual
GLEN ELLIS BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
161 COMEAUX RD, RAYVILLE, LA 71269
(318) 303-5500
Mailing address
PO BOX 745, RAYVILLE, LA 71269-0745
(318) 303-5500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4056
LA
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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