| Drlullaby, Llc | |
|
1102a Delaware Ave Mccomb MS 39648-3830 | |
| (844) 475-3379 | |
| Not Available |
| Full Name | Drlullaby, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1102a Delaware Ave, Mccomb, Mississippi |
| Authorized Official Name and Position | Lisa Ann Medalie (CEO) |
| Authorized Official Contact | 6199975759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drlullaby, Llc 1440 W Taylor St # 556 Chicago IL 60607-4623 Ph: (844) 475-3379 | Drlullaby, Llc 1102a Delaware Ave Mccomb MS 39648-3830 Ph: (844) 475-3379 |
| NPI Number | 1063128635 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Medicare PECOS PAC ID | 9931507290 |
|---|---|
| Medicare Enrollment ID | O20230323002675 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063128635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Anderson Rowan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356377527 PECOS PAC ID: 8729452594 Enrollment ID: I20230323002849 |
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