Provider Demographics
NPI:1467178566
Name:ESSARY, WESLEY HAROLD (CCSS)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:HAROLD
Last Name:ESSARY
Suffix:
Gender:M
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 SOUTH HARPER ROAD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-287-4424
Mailing Address - Fax:662-287-4114
Practice Address - Street 1:2644 SOUTH HARPER ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-287-4424
Practice Address - Fax:662-287-4114
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1699869537261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1699869537Medicaid