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17095 Fenton Dedeaux Rd Kiln MS 39556-6931 | |
(318) 416-2208 | |
Not Available |
Full Name | |
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Speciality | Behavior Analyst |
Location | 17095 Fenton Dedeaux Rd, Kiln, Mississippi |
Authorized Official Name and Position | Lexie Jo Cupp (PRESIDENT) |
Authorized Official Contact | 3184162208 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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17095 Fenton Dedeaux Rd Kiln MS 39556-6931 Ph: (318) 416-2208 | 17095 Fenton Dedeaux Rd Kiln MS 39556-6931 Ph: (318) 416-2208 |
NPI Number | 1457734824 |
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Provider Enumeration Date | 07/03/2015 |
Last Update Date | 07/03/2015 |
Identifier | Type | State | Issuer |
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1457734824 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103K00000X | Behavior Analyst | 11314174 (* (Not Available)) | Primary |