MEDICARE: PASSIONATE LIVING COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1023575347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSIONATE LIVING COUNSELING

Provider Business Mailing Address
First Line	:	1755 LELIA DR STE 105
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4828
Country	:	US
Telephone Number	:	601-925-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 LELIA DR STE 105
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4828
Country	:	US
Telephone Number	:	601-925-0707
Fax Number	:

Authorized Official
Title or Position	:	MAIN COUNSELOR/THERAPIST
Name	:	MR. PHILIP HARDIN
Credential	:	LPC, LMFT
Telephone Number	:	601-925-0707

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	02/22/2019

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Directions to “PASSIONATE LIVING COUNSELING ” Practice Location

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