Healthcare Provider Details

I. General information

NPI: 1730663469
Provider Name (Legal Business Name): ESSENTIAL TOUCHTONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W. JACKSON STREET
RIDGELAND MS
39157
US

IV. Provider business mailing address

210 W. JACKSON STREET
RIDGELAND MS
39157
US

V. Phone/Fax

Practice location:
  • Phone: 769-231-9414
  • Fax: 601-707-7291
Mailing address:
  • Phone: 769-231-9414
  • Fax: 601-707-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA KILLEBREW
Title or Position: OWNER
Credential: PHD
Phone: 601-750-6102