Individual
MR. BRUCE ELLIS MILES SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1255 SHREVEPORT BARKSDALE HWY, SHREVEPORT, LA 71105-2405
(318) 861-1776
Mailing address
405 CLERK ST, MINDEN, LA 71055-2415
(318) 207-7265
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5552
LA
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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