Healthcare Provider Details

I. General information

NPI: 1205037512
Provider Name (Legal Business Name): JANISE A. HINSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I-55 NORTH SUITE #208 HIGHLAND VILLAGE
JACKSON MS
39211
US

IV. Provider business mailing address

4500 I-55 NORTH SUITE #208 HIGHLAND VILLAGE
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-5757
  • Fax:
Mailing address:
  • Phone: 601-981-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number44709
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number25213T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: