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General NPI Number Information
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NPI Number | 1386288900
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Entity Type | Individual
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Provider Name | SHERITA PRELOW BROWN-MIMS LPC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 6042 ALASKA LN
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City | SHREVEPORT
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State | LA
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Zip | 71107-2004
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Country | US
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Telephone | 318-780-2335
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Fax | 318-489-4217
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Provider Business Mailing Address
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Address Line | 6042 ALASKA LN
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City | SHREVEPORT
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State | LA
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Zip | 71107-2004
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Country | US
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Telephone | 318-780-2335
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Fax | 318-489-4217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5664
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License Number State | LA
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