Organization
PRISM PSYCH, PLLC
Active
Other names
Prism Psych, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATOYA R FAVRE PHD (LICENSED PSYCHOLOGIST)
(423) 748-2966
Entity
Organization
Contact information
Practice address
2817 BLACKFOOT RD, VANCLEAVE, MS 39565-8321
(423) 748-2966
(615) 247-6510
Mailing address
2817 BLACKFOOT RD, VANCLEAVE, MS 39565-8321
(423) 748-2966
(615) 247-6510
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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