MEDICARE: MS. HENNA PATEL

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	PLPC9405	LA

General Provider Information

NPI Number	:	1912690660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HENNA PATEL

Provider Business Mailing Address
First Line	:	4109 CHAUVIN LN
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-2058
Country	:	US
Telephone Number	:	901-412-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7437
Country	:	US
Telephone Number	:	318-350-6030
Fax Number	:

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

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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