MEDICARE: DR. DOROTHY J MCGILL PHD, LCMHT

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	101YM0800X	Mental Health Counselor	LH0186	MS

General Provider Information

NPI Number	:	1578677720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY J MCGILL PHD, LCMHT

Provider Business Mailing Address
First Line	:	4542 VILLAGE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3357
Country	:	US
Telephone Number	:	601-952-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	357 TOWNE CENTER BLVD
Second Line	:	SUITE 100
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4837
Country	:	US
Telephone Number	:	601-952-0894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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