Healthcare Provider Details

I. General information

NPI: 1700796836
Provider Name (Legal Business Name): JULIA MABUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LAKELAND DR
JACKSON MS
39216-4829
US

IV. Provider business mailing address

117 SUNLINE DR
BRANDON MS
39042-1918
US

V. Phone/Fax

Practice location:
  • Phone: 769-777-1143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3508
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: