Provider Demographics
NPI:1023364163
Name:MISSISSIPPI COUNSELING CENTER,CORP
Entity Type:Organization
Organization Name:MISSISSIPPI COUNSELING CENTER,CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-214-1497
Mailing Address - Street 1:PO BOX 11886
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39283-1886
Mailing Address - Country:US
Mailing Address - Phone:601-214-1497
Mailing Address - Fax:
Practice Address - Street 1:2460 TERRY RD STE 350
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-5767
Practice Address - Country:US
Practice Address - Phone:601-214-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty