Provider Demographics
NPI:1447637103
Name:BROWN, KEITH MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 CARROLLTON AVE APT 320
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1889
Mailing Address - Country:US
Mailing Address - Phone:504-813-1350
Mailing Address - Fax:
Practice Address - Street 1:1 GALLERIA BLVD STE 1900
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7553
Practice Address - Country:US
Practice Address - Phone:504-321-1941
Practice Address - Fax:504-613-4923
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional