Healthcare Provider Details

I. General information

NPI: 1699572115
Provider Name (Legal Business Name): COLBY URIAH CUEVAS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N MADISON ST
TUPELO MS
38804-3807
US

IV. Provider business mailing address

PO BOX 394
TUPELO MS
38802-0394
US

V. Phone/Fax

Practice location:
  • Phone: 662-687-3280
  • Fax:
Mailing address:
  • Phone: 662-687-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3228
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: