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General NPI Number Information
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NPI Number | 1649081217
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Entity Type | Individual
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Provider Name | STEPHEN NEVILL
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Gender | Male
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 304 EMERALD LN
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City | HATTIESBURG
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State | MS
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Zip | 39401-6313
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Country | US
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Telephone | 601-268-8796
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Fax |
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Provider Business Mailing Address
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Address Line | 26 DEERFIELD
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City | HATTIESBURG
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State | MS
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Zip | 39402-8316
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Country | US
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Telephone | 662-420-0111
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3223
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License Number State | MS
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