Provider Demographics
NPI:1861988057
Name:YOUNG, BRENDA EDWARDS
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:EDWARDS
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-4640
Mailing Address - Country:US
Mailing Address - Phone:985-212-9097
Mailing Address - Fax:
Practice Address - Street 1:501 RUE DE SANTE STE 4
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-652-7840
Practice Address - Fax:985-652-7830
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator