| Mainka Teletherapy Services, Llc | |
|
1210 Polk St Vicksburg MS 39180-5024 | |
| (601) 456-2633 | |
| Not Available |
| Full Name | Mainka Teletherapy Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1210 Polk St, Vicksburg, Mississippi |
| Authorized Official Name and Position | Alicia Mainka (OWNER) |
| Authorized Official Contact | 6014562633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mainka Teletherapy Services, Llc 665 S Pear Orchard Rd Ste 106-701 Ridgeland MS 39157-4861 Ph: (601) 456-2633 | Mainka Teletherapy Services, Llc 1210 Polk St Vicksburg MS 39180-5024 Ph: (601) 456-2633 |
| NPI Number | 1700648631 |
|---|---|
| Provider Enumeration Date | 01/25/2024 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 9335583541 |
|---|---|
| Medicare Enrollment ID | O20240215002627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700648631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alicia D Mainka |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477850618 PECOS PAC ID: 2769826965 Enrollment ID: I20240215002353 |
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