Organization
FAIR PARK COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY W FERGUSON LPC (CEO)
(662) 760-0052
Entity
Organization
Contact information
Practice address
210 E MAIN ST STE 2C, TUPELO, MS 38804-4017
(662) 760-0052
(662) 495-4080
Mailing address
210 E MAIN ST STE 2C, TUPELO, MS 38804-4017
(662) 760-0052
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
08/30/2018
Last updated
11/07/2021
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