Healthcare Provider Details

I. General information

NPI: 1346688132
Provider Name (Legal Business Name): BELLAMY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 TIKI LN
JACKSON MS
39212-3657
US

IV. Provider business mailing address

PO BOX 12395
JACKSON MS
39236-2395
US

V. Phone/Fax

Practice location:
  • Phone: 601-405-2638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA BELLAMY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, NCC
Phone: 601-405-2638