Provider Demographics
NPI:1689331142
Name:BROWN, MICHELE LEIGH (CIT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2969
Mailing Address - Country:US
Mailing Address - Phone:318-505-7001
Mailing Address - Fax:318-227-1472
Practice Address - Street 1:2419 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2969
Practice Address - Country:US
Practice Address - Phone:318-505-7001
Practice Address - Fax:318-227-1472
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)