Healthcare Provider Details

I. General information

NPI: 1962824920
Provider Name (Legal Business Name): MIRANDA BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA WARREN LPC

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

11990 JACKSON ST
CLINTON LA
70722-3210
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax:
Mailing address:
  • Phone: 225-683-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: