=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336836212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEL HECKMAN THRASH LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2023
-----------------------------------------------------
Last Update Date | 04/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5611 HIGHWAY 80 E
-----------------------------------------------------
City | PEARL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39208-8929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-939-6634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6351 ATTALA ROAD 4227
-----------------------------------------------------
City | WEST
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39192-7754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-319-7011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1972
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------