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General NPI Number Information
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NPI Number | 1922513761
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Entity Type | Organization
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Legal Business Name | SHOUTED SILENCE SERVICES, LLC
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 907 CARTER AVE STE 3
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3645
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Country | US
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Telephone | 601-650-8150
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Fax | 601-429-9281
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Provider Business Mailing Address
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Address Line | PO BOX 1111
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City | PHILADELPHIA
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State | MS
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Zip | 39350-1111
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Country | US
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Telephone | 601-650-8150
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Fax | 601-650-8150
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | AMANDA GAIL CONERLY
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Credential | LPC, NCC
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Telephone | 601-650-8150
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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 | 1588
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License Number State | MS
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