Healthcare Provider Details

I. General information

NPI: 1285935932
Provider Name (Legal Business Name): SUMMIT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N STATE ST
JACKSON MS
39201-1108
US

IV. Provider business mailing address

431 N STATE ST
JACKSON MS
39201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 601-949-1949
  • Fax: 601-714-6922
Mailing address:
  • Phone: 601-949-1949
  • Fax: 601-714-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RON MUMBOWER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 601-949-1949