MEDICARE: JAMES LAWRENCE LMSW

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	1041C0700X	Clinical Social Worker	10596	MS
2	101YM0800X	Mental Health Counselor	4939	MS

General Provider Information

NPI Number	:	1679297311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LAWRENCE LMSW

Provider Business Mailing Address
First Line	:	87 WOODVILLE TRCE
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8347
Country	:	US
Telephone Number	:	228-447-5265
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 BROADWAY DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-5074
Country	:	US
Telephone Number	:	228-447-5265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	08/12/2025

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