Healthcare Provider Details

I. General information

NPI: 1437932845
Provider Name (Legal Business Name): CPPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 COLLEGE ST
COLUMBUS MS
39701-5772
US

IV. Provider business mailing address

423 COLLEGE ST
COLUMBUS MS
39701-5772
US

V. Phone/Fax

Practice location:
  • Phone: 662-769-2331
  • Fax:
Mailing address:
  • Phone: 662-769-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C PETERSON
Title or Position: OWNER
Credential: LPC
Phone: 662-769-2331