Provider Demographics
NPI:1013069285
Name:CALHOUN, JOANNE PRINDEL (PHD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:PRINDEL
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2838
Mailing Address - Country:US
Mailing Address - Phone:228-388-9303
Mailing Address - Fax:228-388-9306
Practice Address - Street 1:904 DESOTO ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3737
Practice Address - Country:US
Practice Address - Phone:228-872-8429
Practice Address - Fax:228-872-0226
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19-220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS30136OtherNATIONAL REGISTER
MS00110022Medicaid