Healthcare Provider Details

I. General information

NPI: 1881353779
Provider Name (Legal Business Name): MISTY ELLE LAUREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISTY LAUREN FRIDDLE

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KING PLZ STE D
COMMERCE TX
75428-3734
US

IV. Provider business mailing address

PO BOX 1372
SULPHUR SPRINGS TX
75483-1372
US

V. Phone/Fax

Practice location:
  • Phone: 903-440-4407
  • Fax:
Mailing address:
  • Phone: 903-440-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number62148
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: