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General NPI Number Information
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NPI Number | 1447132287
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Entity Type | Organization
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Legal Business Name | MAGNOLIA TIDES COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2124 GOVERNMENT ST
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3937
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Country | US
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Telephone | 601-436-9514
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Fax |
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Provider Business Mailing Address
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Address Line | 5390 OVERLAND DR
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City | BILOXI
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State | MS
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Zip | 39532-8590
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Country | US
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Telephone | 601-436-9514
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | EVE G SELF
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Credential | LPC-S
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Telephone | 601-436-9514
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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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