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General NPI Number Information
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NPI Number | 1700237039
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Entity Type | Organization
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Legal Business Name | LIVE AND LEARN INC.
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 10/27/2017
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Provider Practice Location Address
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Address Line | 353 BELLS FERRY DR
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City | BILOXI
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State | MS
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Zip | 39531-2258
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Country | US
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Telephone | 601-384-7551
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Fax |
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Provider Business Mailing Address
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Address Line | 989 GREYSTONE DR
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City | BILOXI
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State | MS
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Zip | 39532-2251
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Country | US
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Telephone | 601-384-7551
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Fax |
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Authorized Official
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Title or Position | THERAPIST,PSYCHOMETRIST,
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Name | MRS. CAMILLA JOY MOORE
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Credential | LPC, NCC
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Telephone | 601-384-7551
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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 | 2191
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 2191
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2191
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License Number State | MS
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