Healthcare Provider Details

I. General information

NPI: 1972946754
Provider Name (Legal Business Name): JO ANN WILBANKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S THOMAS ST STE 116
TUPELO MS
38801-5300
US

IV. Provider business mailing address

161 MEGS LN
SALTILLO MS
38866-7939
US

V. Phone/Fax

Practice location:
  • Phone: 662-816-4674
  • Fax: 478-800-6754
Mailing address:
  • Phone: 662-665-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1619
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: