Provider Demographics
NPI:1760716385
Name:SYCAMORE TREE COUNSELING SERVICES
Entity Type:Organization
Organization Name:SYCAMORE TREE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-545-2442
Mailing Address - Street 1:207 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3868
Mailing Address - Country:US
Mailing Address - Phone:601-545-2442
Mailing Address - Fax:601-545-2443
Practice Address - Street 1:207 3RD AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3868
Practice Address - Country:US
Practice Address - Phone:601-545-2442
Practice Address - Fax:601-545-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC49451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty