Provider Demographics
NPI:1346634805
Name:MISS-LOU WELLNESS CONSULTANTS
Entity Type:Organization
Organization Name:MISS-LOU WELLNESS CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GETTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:601-487-6894
Mailing Address - Street 1:5839 PEAR ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3311
Mailing Address - Country:US
Mailing Address - Phone:601-487-6894
Mailing Address - Fax:601-487-6894
Practice Address - Street 1:5839 PEAR ORCHARD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3311
Practice Address - Country:US
Practice Address - Phone:601-487-6894
Practice Address - Fax:601-487-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0015034Medicaid