| Family Coaching Clinic | |
|
105 Executive Dr Ste B Madison MS 39110-8496 | |
| (601) 506-2292 | |
| Not Available |
| Full Name | Family Coaching Clinic |
|---|---|
| Speciality | Counselor |
| Location | 105 Executive Dr Ste B, Madison, Mississippi |
| Authorized Official Name and Position | John Webb (DIRECTOR) |
| Authorized Official Contact | 6015062292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Coaching Clinic 52 Redbud Ln Madison MS 39110-9261 Ph: (601) 506-2292 | Family Coaching Clinic 105 Executive Dr Ste B Madison MS 39110-8496 Ph: (601) 506-2292 |
| NPI Number | 1730869892 |
|---|---|
| Provider Enumeration Date | 07/24/2023 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/22/2023 |
| Medicare PECOS PAC ID | 9638618416 |
|---|---|
| Medicare Enrollment ID | O20240823002883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730869892 | NPI | - | NPPES |
| Provider Name | John C Webb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245592450 PECOS PAC ID: 0547709321 Enrollment ID: I20240823002990 |
| Provider Name | Sage H Conner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417651449 PECOS PAC ID: 3971034182 Enrollment ID: I20240930000183 |
| Provider Name | Tarea L Stout |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063997955 PECOS PAC ID: 2961933171 Enrollment ID: I20240930000204 |
| Provider Name | Latesah Rosha Burks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700620960 PECOS PAC ID: 5092246041 Enrollment ID: I20241002001173 |
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