MEDICARE: PSYCHOLOGICAL EDUCATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1214764	OTHER	MS	MS SECRETARY OF STATE BUSINESS ID

General Provider Information

NPI Number	:	1205451267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL EDUCATION INC

Provider Business Mailing Address
First Line	:	4611 JONATHAN DR
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-8959
Country	:	US
Telephone Number	:	302-222-7235
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 JONATHAN DR
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-8959
Country	:	US
Telephone Number	:	302-222-7235
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JOSEPH BEN PIERCY
Credential	:	ICADC, LPC
Telephone Number	:	302-222-7235

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	11/27/2023

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