Healthcare Provider Details

I. General information

NPI: 1689903254
Provider Name (Legal Business Name): CRYSTAL CORSHE' BIGGS LMSW, PCMHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SOUTHLAKE CIR
CANTON MS
39046-5369
US

IV. Provider business mailing address

PO BOX 526
CANTON MS
39046-0526
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-8371
  • Fax: 601-859-5433
Mailing address:
  • Phone: 601-859-8371
  • Fax: 601-859-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5022
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW0000007841
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: