Healthcare Provider Details

I. General information

NPI: 1831627405
Provider Name (Legal Business Name): COUNSELING FOR A CAUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
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
TUPELO MS
38801-6558
US

V. Phone/Fax

Practice location:
  • Phone: 662-346-4584
  • Fax: 662-346-4589
Mailing address:
  • Phone: 662-687-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2058
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY A PHILLIPS
Title or Position: OWNER/CEO
Credential: LPC
Phone: 662-687-0833