Healthcare Provider Details

I. General information

NPI: 1780950907
Provider Name (Legal Business Name): PSYCHOLOGICAL CARE SERVICES OF MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MARKET ST
FLOWOOD MS
39232-3339
US

IV. Provider business mailing address

109 DOUBLOON DR
SLIDELL LA
70461-2715
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-2513
  • Fax: 985-265-4155
Mailing address:
  • Phone: 985-641-2513
  • Fax: 985-265-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GERTRUDE M PARKER
Title or Position: SOLE MBR
Credential:
Phone: 985-641-2513