MEDICARE: MRS. PHYLLIS G. FALCON LPC

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	101YP2500X	Professional Counselor	1232	MS

General Provider Information

NPI Number	:	1881922276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHYLLIS G. FALCON LPC

Provider Business Mailing Address
First Line	:	205 RIDGEWAY DRIVE
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507
Country	:	US
Telephone Number	:	228-806-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 RIDGEWAY DR
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3920
Country	:	US
Telephone Number	:	228-806-0168
Fax Number	:

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	04/12/2026

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