Organization
PSYCHOSOCIAL BOUTIQUE, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYRENIA JOHNSON LCSW (OWNER/PRACTITIONER)
(662) 892-2660
Entity
Organization
Contact information
Practice address
1751 DANCY BLVD, HORN LAKE, MS 38637-1916
(662) 892-2660
Mailing address
1350 SUNSET DR STE D, GRENADA, MS 38901-4079
(662) 892-2660
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/14/2019
Last updated
11/29/2025
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