Healthcare Provider Details

I. General information

NPI: 1841120730
Provider Name (Legal Business Name): TALIA BRYNNE WEBSTER P-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N GLOSTER ST STE F
TUPELO MS
38804-1239
US

IV. Provider business mailing address

174 HIGHLAND DR
PONTOTOC MS
38863-2706
US

V. Phone/Fax

Practice location:
  • Phone: 662-694-0260
  • Fax:
Mailing address:
  • Phone: 601-663-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1520
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: