=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972622108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES P SORIANO LPC, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 09/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 23RD AVE
-----------------------------------------------------
City | GULFPORT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39501-4612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-547-6459
-----------------------------------------------------
Fax | 855-461-3511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 715
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39560-0715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-256-4052
-----------------------------------------------------
Fax | 855-461-3511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0870
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000029
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 870
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------