MEDICARE: DEFINING YOU THERAPEUTIC SERVICES

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1598346041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFINING YOU THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	10 CANEBRAKE BLVD
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-2211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 TERRY RD STE 1
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3071
Country	:	US
Telephone Number	:	601-278-7137
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KANDACE ROSS
Credential	:
Telephone Number	:	601-278-7137

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	11/07/2021

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