Provider Demographics
NPI:1154737831
Name:BROWN, CHASITI
Entity type:Individual
Prefix:
First Name:CHASITI
Middle Name:
Last Name:BROWN
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:PO BOX 29372
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71149-9372
Mailing Address - Country:US
Mailing Address - Phone:318-670-8898
Mailing Address - Fax:318-300-3772
Practice Address - Street 1:5902 BUNCOMBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4004
Practice Address - Country:US
Practice Address - Phone:318-670-8898
Practice Address - Fax:318-300-3772
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator