=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114633971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHTS CHRISTIAN COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2023
-----------------------------------------------------
Last Update Date | 03/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240B COURTHOUSE RD
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39507-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-865-1330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 BEATLINE RD APT 14C
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39560-4125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LISA PARSONS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 228-865-1330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------