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General NPI Number Information
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NPI Number | 1558529289
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Entity Type | Organization
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Legal Business Name | STARKVILLE COUNSELING ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 205 S LAFAYETTE ST
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City | STARKVILLE
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State | MS
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Zip | 39759-3209
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Country | US
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Telephone | 662-323-5588
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Fax | 662-323-5552
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Provider Business Mailing Address
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Address Line | 205 S LAFAYETTE ST
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City | STARKVILLE
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State | MS
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Zip | 39759-3209
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Country | US
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Telephone | 662-323-5588
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Fax | 662-323-5552
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LESLIE P. FYE
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Credential | MS, LPC
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Telephone | 662-323-5588
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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 | 1128
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0745
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License Number State | MS
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