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General NPI Number Information
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NPI Number | 1265807903
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Entity Type | Organization
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Legal Business Name | HEALING SPIRIT COUNSELING SERVICE LLC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 629 CONSTITUTION DR
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City | IUKA
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State | MS
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Zip | 38852-8201
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Country | US
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Telephone | 662-665-2457
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Fax | 662-423-3331
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Provider Business Mailing Address
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Address Line | 287 COUNTY ROAD 175
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City | IUKA
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State | MS
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Zip | 38852
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Country | US
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Telephone | 662-665-2457
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Fax | 662-423-3331
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Authorized Official
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Title or Position | LPC, OWNER
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Name | KATHY PUTMAN TWITTY
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Credential | LPC
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Telephone | 662-665-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1116
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License Number State | MS
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