| Fpc Intensive Outpatient Program | |
|
210 E Main St Ste 2c Tupelo MS 38804-4017 | |
| (662) 760-0052 | |
| (662) 495-4080 |
| Full Name | Fpc Intensive Outpatient Program |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 210 E Main St Ste 2c, Tupelo, Mississippi |
| Authorized Official Name and Position | Madison Michelle Ashby (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 6628716657 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fpc Intensive Outpatient Program 210 E Main St Ste 2c Tupelo MS 38804-4017 Ph: (662) 760-0052 | Fpc Intensive Outpatient Program 210 E Main St Ste 2c Tupelo MS 38804-4017 Ph: (662) 760-0052 |
| NPI Number | 1306572235 |
|---|---|
| Provider Enumeration Date | 07/25/2022 |
| Last Update Date | 07/25/2022 |
| Certification Date | 07/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306572235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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