Provider Demographics
NPI:1891243556
Name:ALLEN, MIRANDA WILLIAMS
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:WILLIAMS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 INDEPENDENCE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3566
Mailing Address - Country:US
Mailing Address - Phone:318-542-4288
Mailing Address - Fax:318-300-1233
Practice Address - Street 1:3921 INDEPENDENCE DR STE 104
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3566
Practice Address - Country:US
Practice Address - Phone:318-542-4288
Practice Address - Fax:318-300-1233
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health