Provider Demographics
NPI:1700330156
Name:MISSISSIPPI COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:MISSISSIPPI COUNSELING ASSOCIATES
Other - Org Name:JACKSON FAMILY COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:321-480-5000
Mailing Address - Street 1:4500 I 55 FRONTAGE RD N STE 241
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5983
Mailing Address - Country:US
Mailing Address - Phone:321-480-5000
Mailing Address - Fax:
Practice Address - Street 1:4500 I 55 FRONTAGE RD N STE 241
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5983
Practice Address - Country:US
Practice Address - Phone:321-480-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-14
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2099251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health