Healthcare Provider Details

I. General information

NPI: 1689000317
Provider Name (Legal Business Name): AUGUST IRVING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LEAKE ST
CLINTON MS
39056-4253
US

IV. Provider business mailing address

PO BOX 433
CLINTON MS
39060-0433
US

V. Phone/Fax

Practice location:
  • Phone: 601-953-7064
  • Fax: 601-369-0264
Mailing address:
  • Phone: 601-953-7064
  • Fax: 601-364-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1789
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1789
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: