Healthcare Provider Details

I. General information

NPI: 1275282311
Provider Name (Legal Business Name): BEHAVIORAL CONSULTANT SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 ABBEY CT
BILOXI MS
39531-4023
US

IV. Provider business mailing address

18 ERLENE WATTS RD
RICHTON MS
39476-9113
US

V. Phone/Fax

Practice location:
  • Phone: 601-408-0719
  • Fax:
Mailing address:
  • Phone: 601-408-0719
  • 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 Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDRICK T HIBBLER
Title or Position: MANAGER
Credential:
Phone: 601-408-0719