Provider Demographics
NPI:1912777137
Name:BELL, TAVOIYA MONIQUE (LPC-MHSPT, NCC)
Entity Type:Individual
Prefix:
First Name:TAVOIYA
Middle Name:MONIQUE
Last Name:BELL
Suffix:
Gender:F
Credentials:LPC-MHSPT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WHISTLE CV
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8507
Mailing Address - Country:US
Mailing Address - Phone:901-598-3099
Mailing Address - Fax:
Practice Address - Street 1:1515 WHISTLE CV
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-8507
Practice Address - Country:US
Practice Address - Phone:901-598-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5683101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health