Provider Demographics
NPI:1336339498
Name:WORSHAM, JERRY DEAN JR (LPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DEAN
Last Name:WORSHAM
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8114
Mailing Address - Country:US
Mailing Address - Phone:662-513-3411
Mailing Address - Fax:
Practice Address - Street 1:510 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-8114
Practice Address - Country:US
Practice Address - Phone:662-513-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health