Healthcare Provider Details

I. General information

NPI: 1306185251
Provider Name (Legal Business Name): HEART TO HEART OUTREACH MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LEE ANDERSON RD
LUCEDALE MS
39452-8400
US

IV. Provider business mailing address

PO BOX 10497
GULFPORT MS
39505-0497
US

V. Phone/Fax

Practice location:
  • Phone: 228-265-1535
  • Fax:
Mailing address:
  • Phone: 228-265-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberSA708302
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSA708302
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSA708302
License Number StateMS

VIII. Authorized Official

Name: SHERRIE A. ANDERSON
Title or Position: VICE PRESIDENT
Credential: BS, BCPC, LMFC
Phone: 228-218-6795