Provider Demographics
NPI:1093463754
Name:MUSE, FATIMA LA'JUAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:LA'JUAN
Last Name:MUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1428
Mailing Address - Country:US
Mailing Address - Phone:214-302-7012
Mailing Address - Fax:
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 305
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4229
Practice Address - Country:US
Practice Address - Phone:214-302-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist