Provider Demographics
NPI:1871200071
Name:MORLEY, MIRANDA DANIE'L (CIT, MHS, BA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DANIE'L
Last Name:MORLEY
Suffix:
Gender:F
Credentials:CIT, MHS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 JACKSON ST STE 119
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3096
Mailing Address - Country:US
Mailing Address - Phone:318-625-7050
Mailing Address - Fax:
Practice Address - Street 1:3600 JACKSON ST STE 119
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3096
Practice Address - Country:US
Practice Address - Phone:318-625-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5537101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3528266Medicaid