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General NPI Number Information
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NPI Number | 1326535477
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Entity Type | Organization
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Legal Business Name | TEW COUNSELING LLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 4500 I 55 N STE 216
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City | JACKSON
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State | MS
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Zip | 39211-5931
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Country | US
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Telephone | 601-718-0328
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 I 55 N STE 216
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City | JACKSON
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State | MS
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Zip | 39211-5931
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Country | US
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Telephone | 601-718-0328
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. NICHOLAS LAMAR TEW
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Credential | LCSW
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Telephone | 601-718-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C6882
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License Number State | MS
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