Basic Information
| Provider Information | |||||||||
| NPI: | 1205353703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANKLIN | ||||||||
| FirstName: | MYRNA | ||||||||
| MiddleName: | SHANNEKIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713733449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183231300 | ||||||||
| FaxNumber: | 3183231400 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713733449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183231300 | ||||||||
| FaxNumber: | 3183231400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.