MEDICARE: JANICE E MIDDLETON 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	101YM0800X	Mental Health Counselor	4787	LA
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	4787	LA

General Provider Information

NPI Number	:	1558732180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE E MIDDLETON LPC

Provider Business Mailing Address
First Line	:	1513 LINE AVE. SUITE 250
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101
Country	:	US
Telephone Number	:	318-347-4437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 KNIGHT ST STE 110
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2412
Country	:	US
Telephone Number	:	318-459-1600
Fax Number	:	318-861-2798

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	11/13/2020

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Directions to “ JANICE E MIDDLETON LPC” Practice Location

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