Healthcare Provider Details

I. General information

NPI: 1871038356
Provider Name (Legal Business Name): WHITNEY MIXON MS,LPC,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67140 INDUSTRY LANE
COVINGTON LA
70433
US

IV. Provider business mailing address

67140 INDUSTRY LANE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-900-2550
  • Fax: 985-900-2552
Mailing address:
  • Phone: 985-900-2550
  • Fax: 985-900-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6155
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: