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General NPI Number Information
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NPI Number | 1366057598
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Entity Type | Organization
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Legal Business Name | YOUR NEW BEGINNING COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/17/2020
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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 | 601-376-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 PECAN BLVD
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City | JACKSON
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State | MS
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Zip | 39209-7146
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Country | US
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Telephone | 601-503-6817
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MISS JESSICA DENISE THOMAS
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Credential | LPC-S
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Telephone | 601-376-9248
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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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