Individual
MARY E. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMHT, LPC
Contact information
Practice address
2100 EAST CHAMBERS STREET, BOONEVILLE, MS 38829
(662) 728-3174
(662) 286-8095
Mailing address
PO BOX 839, CORINTH, MS 38835-0839
(662) 286-2152
(662) 286-8095
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
2590
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2590
DEPARTMENT OF MENTAL HEALTH OF MISSISSIPPI
MS
Enumeration date
01/18/2008
Last updated
07/10/2020
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