=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285934257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRESHOLDS COUNSELING AND CONSULTING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2010
-----------------------------------------------------
Last Update Date | 03/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 CRANE RIDGE DR SUITE A
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39216-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-573-8642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 CRANE RIDGE DR SUITE A
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39216-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-573-8642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTEN RUTH WILLIAMS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 601-573-8642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1471
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------