Healthcare Provider Details

I. General information

NPI: 1568396802
Provider Name (Legal Business Name): MOMME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 LAKELAND EAST DR STE B
FLOWOOD MS
39232-9600
US

IV. Provider business mailing address

132 ASHTON PARK BLVD
MADISON MS
39110-8475
US

V. Phone/Fax

Practice location:
  • Phone: 601-209-9898
  • Fax:
Mailing address:
  • Phone: 601-209-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-209-9898