Individual
CICELY C. TARAVELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1500 E WOODROW WILSON AVE, TRP/MENTAL HEALTH (116A2), JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE, TRP/MENTAL HEALTH (116A2), JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
52903
MS
Other
Enumeration date
10/01/2012
Last updated
10/01/2012
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