Provider Demographics
NPI:1962693580
Name:RANEY, BRENDA TRIPPLETT
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:TRIPPLETT
Last Name:RANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:T
Other - Last Name:RANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:912 MILL ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-3449
Mailing Address - Country:US
Mailing Address - Phone:318-335-3883
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:
Practice Address - City:FT. POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010655441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801065544OtherSOCIAL WORK LIC