Healthcare Provider Details

I. General information

NPI: 1023903341
Provider Name (Legal Business Name): CHAMBLISS COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 GRAVEL HILL RD
FAYETTE MS
39069-5057
US

IV. Provider business mailing address

2076 GRAVEL HILL RD
FAYETTE MS
39069-5057
US

V. Phone/Fax

Practice location:
  • Phone: 601-809-6968
  • Fax: 601-610-7147
Mailing address:
  • Phone: 601-809-6968
  • Fax: 601-610-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS SHARRON CHAMBLISS
Title or Position: LPC, OWNER
Credential: M.S.ED, LPC , NCC
Phone: 601-748-4214