Individual
BRENNON TYLER CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3712 MACARTHUR BLVD STE 100, NEW ORLEANS, LA 70114-6861
(504) 882-8105
Mailing address
500 FAIRWAY DR STE 102, DEERFIELD BEACH, FL 33441-1817
(888) 880-9270
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
Other
Enumeration date
11/04/2018
Last updated
12/26/2020
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