Provider Demographics
NPI:1720566201
Name:RESILIENCE PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:RESILIENCE PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:888-464-1811
Mailing Address - Street 1:3427 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3039
Mailing Address - Country:US
Mailing Address - Phone:888-464-1811
Mailing Address - Fax:800-416-3070
Practice Address - Street 1:3427 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3039
Practice Address - Country:US
Practice Address - Phone:888-464-1811
Practice Address - Fax:800-416-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty