Healthcare Provider Details

I. General information

NPI: 1942397468
Provider Name (Legal Business Name): MISTY M WESTBROOK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MARQUETTE ROAD
BRANDON MS
39042
US

IV. Provider business mailing address

PO BOX 88
BRANDON MS
39043
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-0342
  • Fax: 601-824-0349
Mailing address:
  • Phone: 601-824-0342
  • Fax: 601-824-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0891
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: