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NPI Code Detail

MEDICARE: MARY HATHORN MS

MEDICARE: MARY HATHORN MS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1326232935
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY HATHORN MS
Provider Business Mailing Address
First Line : 4780 I 55 FRONTAGE RD N STE 105
Second Line :
City : JACKSON
State : MS
Zip : 39211-5542
Country : US
Telephone Number : 601-956-4816
Fax Number :
Provider Business Practice Location Address
First Line : 4780 I 55 FRONTAGE RD N STE 105
Second Line :
City : JACKSON
State : MS
Zip : 39211-5542
Country : US
Telephone Number : 601-956-4816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2007
Last Update Date : 08/17/2023

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Directions to “ MARY HATHORN MS” Practice Location

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