Healthcare Provider Details

I. General information

NPI: 1497162341
Provider Name (Legal Business Name): TALUNJA ESKRIDGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 09/17/2019
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

2705 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

V. Phone/Fax

Practice location:
  • Phone: 662-470-5433
  • Fax:
Mailing address:
  • Phone: 662-449-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1936
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: