Healthcare Provider Details

I. General information

NPI: 1467838367
Provider Name (Legal Business Name): NANCY PREVOST JOSEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/20/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 CENTER HILL RD
OLIVE BRANCH MS
38654-8797
US

IV. Provider business mailing address

4680 CENTER HILL RD
OLIVE BRANCH MS
38654-8797
US

V. Phone/Fax

Practice location:
  • Phone: 901-413-6536
  • Fax:
Mailing address:
  • Phone: 901-413-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7981
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1583
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1583
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1583
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: