Provider Demographics
NPI:1912870924
Name:LOUISIANA BRAIN INJURY SPECIALISTS, LLC
Entity type:Organization
Organization Name:LOUISIANA BRAIN INJURY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-849-4140
Mailing Address - Street 1:401 E VEROT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3315
Mailing Address - Country:US
Mailing Address - Phone:337-232-3353
Mailing Address - Fax:
Practice Address - Street 1:401 E VEROT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3315
Practice Address - Country:US
Practice Address - Phone:337-232-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty