| Live Oak Psychological Associtaes | |
|
1151 N State St Ste 212 Jackson MS 39202-2407 | |
| (601) 352-7398 | |
| (601) 352-0442 |
| Full Name | Live Oak Psychological Associtaes |
|---|---|
| Speciality | Psychologist |
| Location | 1151 N State St, Jackson, Mississippi |
| Authorized Official Name and Position | Lisa Halderman Dieth (OFFICE MANAGER) |
| Authorized Official Contact | 6013527398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Psychological Associtaes 1151 N State St Ste 212 Jackson MS 39202-2407 Ph: (601) 352-7398 | Live Oak Psychological Associtaes 1151 N State St Ste 212 Jackson MS 39202-2407 Ph: (601) 352-7398 |
| NPI Number | 1750577805 |
|---|---|
| Provider Enumeration Date | 09/22/2007 |
| Last Update Date | 09/22/2007 |
| Medicare PECOS PAC ID | 9032176698 |
|---|---|
| Medicare Enrollment ID | O20041215000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750577805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | James H Brown |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346374410 PECOS PAC ID: 9032174065 Enrollment ID: I20041201000407 |
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