Provider Demographics
NPI:1891153524
Name:TINA HOOKER COUNSELING SERVICE PLLC
Entity Type:Organization
Organization Name:TINA HOOKER COUNSELING SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-419-1284
Mailing Address - Street 1:425 DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:THAXTON
Mailing Address - State:MS
Mailing Address - Zip Code:38871-9112
Mailing Address - Country:US
Mailing Address - Phone:662-419-1284
Mailing Address - Fax:
Practice Address - Street 1:356 E OXFORD ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2314
Practice Address - Country:US
Practice Address - Phone:662-419-1284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty