Provider Demographics
NPI:1760285563
Name:BREAUX, WILLIE JR (PLPC, PLMFT)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:BREAUX
Suffix:JR
Gender:
Credentials:PLPC, PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870344
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70187-0344
Mailing Address - Country:US
Mailing Address - Phone:504-314-6142
Mailing Address - Fax:
Practice Address - Street 1:2235 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7575
Practice Address - Country:US
Practice Address - Phone:504-309-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLM1531101YM0800X
LAPLC9987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health