Provider Demographics
NPI:1417384736
Name:BOSCO, JOANNA MARSHALL (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARSHALL
Last Name:BOSCO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 LOVERS LANE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-218-4223
Mailing Address - Fax:
Practice Address - Street 1:2124 GOVERNMENT STREET
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5205
Practice Address - Country:US
Practice Address - Phone:228-218-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS497101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health