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General NPI Number Information
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NPI Number | 1558230268
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Entity Type | Organization
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Legal Business Name | BROADER SPECTRUM COUNSELING PLLC
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 2118 OAK GROVE RD STE A
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City | HATTIESBURG
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State | MS
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Zip | 39402-1572
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Country | US
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Telephone | 601-499-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 118 DALE DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1804
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Country | US
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Telephone | 601-316-4756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TENECIA BULLOCK-FUNCHES
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Credential | LPC-S
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Telephone | 601-316-4756
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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 |
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License Number State |
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