Provider Demographics
NPI:1508110917
Name:WILSON-SIGREST, LLC
Entity Type:Organization
Organization Name:WILSON-SIGREST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGREST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:601-398-5436
Mailing Address - Street 1:103 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4309
Mailing Address - Country:US
Mailing Address - Phone:601-398-5436
Mailing Address - Fax:
Practice Address - Street 1:357 TOWNE CENTER BLVD.
Practice Address - Street 2:SUITE 203
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-398-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLPC 0557101YP2500X
MSC53701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty