Provider Demographics
NPI:1912124280
Name:TEMPLE, ERNEST AL III (LPC, NCC, NCSC)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:AL
Last Name:TEMPLE
Suffix:III
Gender:M
Credentials:LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5752
Mailing Address - Country:US
Mailing Address - Phone:228-497-9739
Mailing Address - Fax:
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-769-2315
Practice Address - Fax:228-762-1240
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional