Glen Ellis Brown

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

4056 Issued in LA

Practice address

161 Comeaux Rd
Rayville, LA 71269

Phone

(318) 303-5500

NPI assigned

Nov 23, 2020

Last updated

Nov 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Second Chances Recovery Center LLC

  • Substance Abuse Rehabilitation Facility
  • Rayville, LA
  • NPI 1073122420
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1679177422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712690745",
            "telephone_number": "318-303-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 COMEAUX RD",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "71269",
            "telephone_number": "318-303-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "GLEN",
        "middle_name": "ELLIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "4056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stuart Reed Bostwick
• Evelyn Watson Branch, NP
• Linda Lee Rigal Branch, MS CCC SLP
• Patrice Brass, CIT
• Mary Jones Brooks, LCSW
• Lavietta Anissa Brown
• Lela Brown
• Bruyninckx Medical LLC
• Kyle Bruyninckx, MD
• Sean Patrick Bryan, M.A.

• Addiction (Substance Use Disorder) Counselor in Rayville, LA
• Providers in Rayville, LA by specialty
• Addiction (Substance Use Disorder) Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.