Healthcare Provider Details

I. General information

NPI: 1174313779
Provider Name (Legal Business Name): SHIMIKA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 KEYWAY DR STE A
FLOWOOD MS
39232-8825
US

IV. Provider business mailing address

151 APPLERIDGE DR
BRANDON MS
39047-8245
US

V. Phone/Fax

Practice location:
  • Phone: 601-826-0095
  • Fax:
Mailing address:
  • Phone: 601-201-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: