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General NPI Number Information
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NPI Number | 1174788939
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Entity Type | Individual
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Provider Name | JOHN A RASBERRY, JR. JR. M.ED.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 602 JEFFERSON ST.
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City | TUPELO
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State | MS
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Zip | 38804
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Country | US
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Telephone | 662-841-0881
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Fax |
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Provider Business Mailing Address
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Address Line | 602 JEFFERSON ST.
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City | TUPELO
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State | MS
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Zip | 38804
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Country | US
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Telephone | 662-841-0881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | TO 366
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | TO366
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License Number State | MS
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