Individual
JOHN B. JOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
740 AVIGNON DR STE B, RIDGELAND, MS 39157-5160
(601) 355-8378
(601) 354-5535
Mailing address
740 AVIGNON DR STE B, RIDGELAND, MS 39157-5160
(601) 355-8378
(601) 354-5535
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
33-531
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114506
—
MS
Enumeration date
03/19/2007
Last updated
11/09/2017
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