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General NPI Number Information
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NPI Number | 1891412151
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Entity Type | Organization
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Legal Business Name | BLACK SHEEP COUNSELING, LLC
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 302 S SPRING ST STE 9
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City | TUPELO
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State | MS
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Zip | 38804-4853
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Country | US
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Telephone | 662-523-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 642 ALLEN ST
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City | TUPELO
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State | MS
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Zip | 38804-3741
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Country | US
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Telephone | 662-523-3315
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | BROOKLYN MICHELLE SELLERS
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Credential | M.ED., LPC, BC-TMH
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Telephone | 662-523-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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