Healthcare Provider Details

I. General information

NPI: 1023695004
Provider Name (Legal Business Name): TAYLOR MADE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 EISENHOWER DR STE B
BILOXI MS
39531-3601
US

IV. Provider business mailing address

PO BOX 6771
DIBERVILLE MS
39540-6771
US

V. Phone/Fax

Practice location:
  • Phone: 601-688-4118
  • Fax: 228-220-4226
Mailing address:
  • Phone: 228-760-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TUSHONDA FLEETON BOYD
Title or Position: OWNER
Credential: LCSW
Phone: 228-760-0262