Individual
MRS. MIRANDA EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
709 DAVIDSON ST, TULLAHOMA, TN 37388-3607
(931) 247-7892
Mailing address
709 DAVIDSON ST, TULLAHOMA, TN 37388-3607
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0000008058
TN
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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