Healthcare Provider Details

I. General information

NPI: 1285150862
Provider Name (Legal Business Name): JENNIFER LEDET MIRE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E REYNOLDS DR STE E3
RUSTON LA
71270-2873
US

IV. Provider business mailing address

102 MOSES PL
WEST MONROE LA
71291-7841
US

V. Phone/Fax

Practice location:
  • Phone: 318-232-2232
  • Fax: 318-301-3734
Mailing address:
  • Phone: 318-243-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5434
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: