Healthcare Provider Details

I. General information

NPI: 1255691176
Provider Name (Legal Business Name): RESOLUTION COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OFFICE PARK PLZ
JACKSON MS
39206
US

IV. Provider business mailing address

160 OFFICE PARK PLZ
JACKSON MS
39206-4108
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-3617
  • Fax:
Mailing address:
  • Phone: 601-218-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC6211
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHANIEL MITCHELL
Title or Position: THERAPIST
Credential: LCSW
Phone: 601-218-3617