Provider Demographics
NPI:1740329200
Name:CAREY, JANE DESERN (LPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DESERN
Last Name:CAREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-4616
Mailing Address - Country:US
Mailing Address - Phone:228-313-4441
Mailing Address - Fax:228-863-7174
Practice Address - Street 1:2413 23RD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-4616
Practice Address - Country:US
Practice Address - Phone:228-313-4441
Practice Address - Fax:228-863-7174
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional