Healthcare Provider Details

I. General information

NPI: 1801148739
Provider Name (Legal Business Name): ARMSTRONG COUNSELING & INTENSIVE OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 SWINNEA RDG STE 1
SOUTHAVEN MS
38671-6037
US

IV. Provider business mailing address

7160 ARCASTLE LOOP E
SOUTHAVEN MS
38671-9024
US

V. Phone/Fax

Practice location:
  • Phone: 662-470-6485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1007
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5871
License Number StateMS

VIII. Authorized Official

Name: KYSETA WARNER-ARMSTRONG
Title or Position: PROVIDER
Credential: LPC
Phone: 662-470-6485