Provider Demographics
NPI:1811497464
Name:MPOWER HEALING, PLLC
Entity type:Organization
Organization Name:MPOWER HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DESARAE
Authorized Official - Middle Name:SWILLEY
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-799-9500
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-1111
Mailing Address - Country:US
Mailing Address - Phone:601-799-9500
Mailing Address - Fax:855-675-8575
Practice Address - Street 1:124 KIRKWOOD ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3866
Practice Address - Country:US
Practice Address - Phone:601-799-9500
Practice Address - Fax:855-675-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC69561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00584268Medicaid