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General NPI Number Information
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NPI Number | 1790542454
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Entity Type | Organization
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Legal Business Name | TUPELO CHILDREN'S MANSION, INC.
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1801 E MAIN ST
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City | TUPELO
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State | MS
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Zip | 38804-2934
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Country | US
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Telephone | 662-842-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 E MAIN ST
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City | TUPELO
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State | MS
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Zip | 38804-2934
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Country | US
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Telephone | 662-842-6982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD ALLEN PARKER
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Credential | DSW, LMSW, LPC
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Telephone | 662-842-6982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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