Healthcare Provider Details

I. General information

NPI: 1770494536
Provider Name (Legal Business Name): BRACKISH COUNSELING & PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 MAIN ST
MOSS POINT MS
39563-2700
US

IV. Provider business mailing address

121 LINNET DR
OCEAN SPRINGS MS
39564-9726
US

V. Phone/Fax

Practice location:
  • Phone: 228-760-0939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARTHA JUNE JUNE KIRBY
Title or Position: OWNER
Credential: PLPC
Phone: 228-217-4415