MEDICARE: MRS. JENNIFER LEDET MIRE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5434	LA

General Provider Information

NPI Number	:	1285150862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEDET MIRE LPC

Provider Business Mailing Address
First Line	:	102 MOSES PL
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7841
Country	:	US
Telephone Number	:	318-243-9659
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 N 6TH ST UNIT 2
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4119
Country	:	US
Telephone Number	:	318-737-7201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	08/16/2017

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