Individual
PROF. BRENNA THOMAS JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-BACS
Contact information
Practice address
3601 GERSTNER MEMORIAL BLVD, LAKE CHARLES, LA 70607-3231
(337) 475-9600
(337) 475-9699
Mailing address
3601 GERSTNER MEMORIAL DRIVE, HWY 14, LAKE CHARLES, LA 70607-3231
(337) 475-9500
(337) 475-9699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11081
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
LA
Enumeration date
01/27/2017
Last updated
03/06/2023
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