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General NPI Number Information
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NPI Number | 1194616359
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Entity Type | Organization
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Legal Business Name | FAITH OF A MUSTARD SEED PSYCHIATRIC WELLNESS, PLLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 5600 GOODMAN RD STE H
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7002
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Country | US
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Telephone | 662-356-3816
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Fax | 662-200-4271
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Provider Business Mailing Address
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Address Line | 5600 GOODMAN RD STE H
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7002
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Country | US
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Telephone | 662-356-3816
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Fax | 662-200-4271
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Authorized Official
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Title or Position | OWNER
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Name | ARGARET SHONTA PAYNE
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Credential | PMHNP
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Telephone | 662-356-3816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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