Organization
LIVE OAK PSYCHOLOGICAL ASSOCITAES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA HALDERMAN DIETH (OFFICE MANAGER)
(601) 352-7398
Entity
Organization
Contact information
Practice address
1151 N STATE ST, STE 212, JACKSON, MS 39202-2407
(601) 352-7398
(601) 352-0442
Mailing address
1151 N STATE ST, STE 212, JACKSON, MS 39202-2407
(601) 352-7398
(601) 352-0442
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
09/22/2007
Last updated
09/22/2007
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