MEDICARE: MS. ENA SIMONE GOODS MS

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	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1982766804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ENA SIMONE GOODS MS

Provider Business Mailing Address
First Line	:	9 ROUX 61 DR STE C
Second Line	:
City	:	NATCHEZ
State	:	MS
Zip	:	39120-2176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 E RIVER PL
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-3442
Country	:	US
Telephone Number	:	601-642-8845
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	01/06/2021

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Directions to “ MS. ENA SIMONE GOODS MS” Practice Location

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