Provider Demographics
NPI:1891249090
Name:BRACE MCKELLAR, MARGARET MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MICHELLE
Last Name:BRACE MCKELLAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:M
Other - Last Name:BRACE MCKELLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2020 E 70TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5332
Mailing Address - Country:US
Mailing Address - Phone:318-553-5591
Mailing Address - Fax:318-553-5592
Practice Address - Street 1:2020 E 70TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5332
Practice Address - Country:US
Practice Address - Phone:318-553-5591
Practice Address - Fax:318-553-5592
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5599101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional