Healthcare Provider Details

I. General information

NPI: 1609731843
Provider Name (Legal Business Name): SHELL SPACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2692 W OXFORD LOOP
OXFORD MS
38655-5498
US

IV. Provider business mailing address

573A HIGHWAY 6 W
OXFORD MS
38655-9091
US

V. Phone/Fax

Practice location:
  • Phone: 662-259-8279
  • 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: LAUREN ASHLEY SIMPSON
Title or Position: COUNSELOR
Credential:
Phone: 662-466-1919