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General NPI Number Information
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NPI Number | 1578707212
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Entity Type | Individual
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Provider Name | MR. BRIAN K ERVIN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 430 BAY POINTE CIR
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City | BRANDON
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State | MS
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Zip | 39047-8553
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Country | US
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Telephone | 601-454-4379
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Fax | 601-829-9383
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Provider Business Mailing Address
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Address Line | 1700 W GOVERNMENT ST SUITE C
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City | BRANDON
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State | MS
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Zip | 39042-2417
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Country | US
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Telephone | 601-454-4379
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Fax | 601-829-9383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1946
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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 | T0280
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License Number State | MS
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