Edwin Brennan, PHD, LP
Individual provider Active NPI Health Service Psychologist · Leesville, LA
NPI 1295196152 · NPPES record last updated Sep 27, 2022
Key facts
- NPI
- 1295196152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Service Psychologist 103TH0100X
- Practice address
- 3353 University Pkwy
Leesville, LA 71446-9041 - Phone
- (337) 392-3800
- NPI assigned
- Mar 18, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1544 | LA | MD | Addiction (Substance Use Disorder) Counselor |
| 6401014593 | MI | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6401014593 | MI | |
| Health Service Psychologist | 103TH0100X | 1544 | LA | |
| Health Service Psychologist | 103TH0100X | Yes |
Addresses
Primary practice location
3353 University Pkwy
Leesville, LA 71446-9041
Mailing address
Fort Polk VA Outpatient Clinic
3353 University Parkway
Leesville, la 71446, LA 71446
Phone (373) 392-3800
Other practice location 1
4765 Timberland Dr
Berrien Springs, MI 49103-1430
Phone (269) 697-9623
Other providers in Leesville, LA
- Jacob Colman Blakeman
- Jashua Bower
- Boxed in Non-Emergency Medical Transportation Services
- Sarah Kathleen Brack
- Charlotte Brady
- Brentwood Acquisition-Shreveport Inc.
- Kaitlyn P Briscoe
- Jaclyn Denise Brooks
- Jeana Marie Brooks
- Jacob Steven Broussard
All providers in Leesville, LA · Health Service Psychologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.