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General NPI Number Information
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NPI Number | 1518747567
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI STATE UNIVERSITY
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 223 FAMOUS MAROON BAND STREET
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City | MISSISSIPPI STATE
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State | MS
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Zip | 39762
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Country | US
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Telephone | 662-325-0621
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Fax | 662-325-0895
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Provider Business Mailing Address
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Address Line | PO BOX 6124
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City | MISSISSIPPI STATE
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State | MS
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Zip | 39762-6124
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Country | US
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Telephone | 662-325-0621
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Fax | 662-325-0895
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Authorized Official
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Title or Position | DIRECTOR, FISCAL OPERATIONS, STUDEN
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Name | DANIEL TODD HALE
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Credential |
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Telephone | 662-325-5895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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