Provider Demographics
NPI:1548913668
Name:KELLUM, BRANDY LEE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:KELLUM
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 1:2113 RIVER QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-3521
Mailing Address - Country:US
Mailing Address - Phone:504-295-5835
Mailing Address - Fax:
Practice Address - Street 1:2113 RIVER QUEEN DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-3521
Practice Address - Country:US
Practice Address - Phone:504-295-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)