Healthcare Provider Details

I. General information

NPI: 1679618276
Provider Name (Legal Business Name): BARRY CLINTON CLICK DOCTOR OF MINISTRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BARRY CLINTON CLICK D.MIN.

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST STE 210
JACKSON MS
39202-2064
US

IV. Provider business mailing address

135 AZALEA TRAILS DR
BRANDON MS
39047-7924
US

V. Phone/Fax

Practice location:
  • Phone: 601-973-1697
  • Fax: 601-974-6260
Mailing address:
  • Phone: 601-992-9960
  • Fax: 601-974-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number473
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: