| Cardinal Clinical Consulting, Llc | |
|
2625 Traceland Dr Ste B Tupelo MS 38801-4240 | |
| (662) 269-3599 | |
| (662) 259-2503 |
| Full Name | Cardinal Clinical Consulting, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2625 Traceland Dr Ste B, Tupelo, Mississippi |
| Authorized Official Name and Position | Joshua C Fulwiler (OWNER) |
| Authorized Official Contact | 6622693599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cardinal Clinical Consulting, Llc 2625 Traceland Dr Ste B Tupelo MS 38801-4240 Ph: (662) 269-3599 | Cardinal Clinical Consulting, Llc 2625 Traceland Dr Ste B Tupelo MS 38801-4240 Ph: (662) 269-3599 |
| NPI Number | 1417514274 |
|---|---|
| Provider Enumeration Date | 05/28/2019 |
| Last Update Date | 05/28/2019 |
| Medicare PECOS PAC ID | 2163765504 |
|---|---|
| Medicare Enrollment ID | O20190528001502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417514274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joshua Campbell Fulwiler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841674645 PECOS PAC ID: 8628311073 Enrollment ID: I20190816000349 |
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