| Grace Christian Counseling Center | |
|
1414 Cherry St Vicksburg MS 39180-3218 | |
| (601) 636-5703 | |
| (601) 636-5739 |
| Full Name | Grace Christian Counseling Center |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1414 Cherry St, Vicksburg, Mississippi |
| Authorized Official Name and Position | Walter Lee Frazier (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6016365703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Christian Counseling Center 1414 Cherry St Vicksburg MS 39180-3218 Ph: (601) 636-5703 | Grace Christian Counseling Center 1414 Cherry St Vicksburg MS 39180-3218 Ph: (601) 636-5703 |
| NPI Number | 1447295654 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0749285070 |
|---|---|
| Medicare Enrollment ID | O20240130002733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447295654 | NPI | - | NPPES |
| Provider Name | Kathryn Wright |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689059537 PECOS PAC ID: 7416300066 Enrollment ID: I20240130002995 |
| Provider Name | Linda S Tello |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902488851 PECOS PAC ID: 1052764529 Enrollment ID: I20240131003692 |
| Provider Name | Marlon Casy Mcnemar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154728368 PECOS PAC ID: 5193169795 Enrollment ID: I20240222002465 |
| Provider Name | Walter Lee Frazier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033168299 PECOS PAC ID: 9133125354 Enrollment ID: I20240325000428 |
| Provider Name | Samonia Lynn Etheridge |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619014891 PECOS PAC ID: 0042650756 Enrollment ID: I20240429002233 |
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