Healthcare Provider Details

I. General information

NPI: 1396218830
Provider Name (Legal Business Name): HEATHER D KENT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 LAKELAND DR
JACKSON MS
39216-4606
US

IV. Provider business mailing address

107 TRADITION PKWY
FLOWOOD MS
39232-8021
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-3158
  • Fax:
Mailing address:
  • Phone: 601-946-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0690
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: