Healthcare Provider Details

I. General information

NPI: 1316257074
Provider Name (Legal Business Name): MAHOGANY MONIQUE BELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAHOGANY MONIQUE STEVENS LCSW

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 CLIFF GOOKIN BLVD STE B
TUPELO MS
38801-6558
US

IV. Provider business mailing address

1893 CLIFF GOOKIN BLVD STE B
TUPELO MS
38801-6558
US

V. Phone/Fax

Practice location:
  • Phone: 662-346-4584
  • Fax: 662-346-4589
Mailing address:
  • Phone: 662-346-4584
  • Fax: 662-346-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7034
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: