Provider Demographics
NPI:1609617919
Name:PASSAFUME, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PASSAFUME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9851 HIGHWAY 178
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3214
Mailing Address - Country:US
Mailing Address - Phone:662-253-8324
Mailing Address - Fax:662-253-8336
Practice Address - Street 1:9851 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3214
Practice Address - Country:US
Practice Address - Phone:662-253-8324
Practice Address - Fax:662-253-8336
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional