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General NPI Number Information
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NPI Number | 1396068326
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Entity Type | Organization
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Legal Business Name | EYES OF THE HEART MINISTRIES
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 402 MONROE ST
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City | CLINTON
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State | MS
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Zip | 39056-4210
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Country | US
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Telephone | 601-924-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 402 MONROE ST
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City | CLINTON
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State | MS
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Zip | 39056-4210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASST. DIRECTOR
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Name | MR. PHILIP PREWETTE
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Credential | M.A.
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Telephone | 601-924-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1113
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0243
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0389
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License Number State | MS
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