Individual
BRANDON SLACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
117 CAROLYN ST, MANSFIELD, LA 71052-2901
(318) 461-1215
Mailing address
117 CAROLYN ST, MANSFIELD, LA 71052-2901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00902654
LA
Other
Enumeration date
10/26/2016
Last updated
10/26/2016
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