=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669854105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALK TIME THERAPEUTIC INTERVENTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2015
-----------------------------------------------------
Last Update Date | 06/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6316 LYNDON B JOHNSON DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39213-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-850-8380
-----------------------------------------------------
Fax | 601-366-9067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6316 LYNDON B JOHNSON DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39213-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-850-8380
-----------------------------------------------------
Fax | 601-366-9067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | COURTNEY R. GRAYSON
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 601-850-8380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | S3703
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------