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General NPI Number Information
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NPI Number | 1215634050
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Entity Type | Organization
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Legal Business Name | TRUECOLORS COUNSELING, LLC.
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 7863 SELF CREEK RD
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City | STARKVILLE
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State | MS
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Zip | 39759-5750
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Country | US
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Telephone | 662-719-0991
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | STARKVILLE
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State | MS
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Zip | 39760-1146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. CODI WALLACE
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Credential | LPC
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Telephone | 662-617-9179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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