MEDICARE: COVENANT COUNSELING P.L.L.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP1600X	Pastoral Counselor
5	103K00000X	Behavior Analyst
6	106H00000X	Marriage & Family Therapist
7	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1235068164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT COUNSELING P.L.L.C.

Provider Business Mailing Address
First Line	:	2113 W WELLSGATE DR
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-6022
Country	:	US
Telephone Number	:	214-796-3565
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 W WELLSGATE DR
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-6022
Country	:	US
Telephone Number	:	214-796-3565
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE ANDREW THOMAS
Credential	:
Telephone Number	:	214-796-3565

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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