Healthcare Provider Details

I. General information

NPI: 1073032421
Provider Name (Legal Business Name): JEREMY SCHRIMSHER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

IV. Provider business mailing address

4740 HIGHWAY 51 N APT 21-102
SOUTHAVEN MS
38671-7993
US

V. Phone/Fax

Practice location:
  • Phone: 662-449-1808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: