Healthcare Provider Details

I. General information

NPI: 1467987701
Provider Name (Legal Business Name): ONE HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DOVE WAY CIR
CLINTON MS
39056-3589
US

IV. Provider business mailing address

1896 HWY. 471
BRANDON MS
39047
US

V. Phone/Fax

Practice location:
  • Phone: 601-201-6862
  • Fax:
Mailing address:
  • Phone: 769-241-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMS

VIII. Authorized Official

Name: ADOOREE MICHELLE TULLAR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 769-241-5146