Provider Demographics
NPI:1902576705
Name:HUSTED, BRANDON (PLPC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HUSTED
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 COCKERHAM RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-2255
Mailing Address - Country:US
Mailing Address - Phone:225-900-8544
Mailing Address - Fax:
Practice Address - Street 1:9171 COCKERHAM RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-2255
Practice Address - Country:US
Practice Address - Phone:225-900-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health