Healthcare Provider Details

I. General information

NPI: 1932403417
Provider Name (Legal Business Name): DEANA M WYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MADISON ST
CORINTH MS
38834-5072
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-2185
  • Fax: 662-728-2345
Mailing address:
  • Phone: 662-728-2185
  • Fax: 662-728-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2134
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: