Healthcare Provider Details

I. General information

NPI: 1548600737
Provider Name (Legal Business Name): A TREE OF LIFE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

186 HIGHWAY 15 S
PONTOTOC MS
38863-3108
US

IV. Provider business mailing address

186 HIGHWAY 15 S
PONTOTOC MS
38863-3108
US

V. Phone/Fax

Practice location:
  • Phone: 662-586-1050
  • Fax:
Mailing address:
  • Phone: 662-586-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA VAIL
Title or Position: ADMINISTRATION
Credential:
Phone: 662-840-4577