Healthcare Provider Details

I. General information

NPI: 1457006090
Provider Name (Legal Business Name): MR. TOMMIE LEE RIMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2022
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S FRONTAGE RD LOT 63
CLINTON MS
39056-6255
US

IV. Provider business mailing address

1401 S FRONTAGE RD LOT 63
CLINTON MS
39056-6255
US

V. Phone/Fax

Practice location:
  • Phone: 601-201-3858
  • Fax:
Mailing address:
  • Phone: 601-201-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number326704
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: