Healthcare Provider Details

I. General information

NPI: 1992247977
Provider Name (Legal Business Name): JESSICA CLEARY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 S HARPER RD
CORINTH MS
38834-6723
US

IV. Provider business mailing address

1310 BRIDLE PATH
CORINTH MS
38834-3809
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4055
  • Fax:
Mailing address:
  • Phone: 662-415-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2274
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2274
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: