| Pax House Counseling And Play Therapy Llc | |
|
210 E Main St Ste 2b Tupelo MS 38804-4017 | |
| (662) 471-4055 | |
| Not Available |
| Full Name | Pax House Counseling And Play Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 210 E Main St Ste 2b, Tupelo, Mississippi |
| Authorized Official Name and Position | Liria Peshkepia (OWNER) |
| Authorized Official Contact | 6624714055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pax House Counseling And Play Therapy Llc 210 E Main St Ste 2b Tupelo MS 38804-4017 Ph: (662) 471-4055 | Pax House Counseling And Play Therapy Llc 210 E Main St Ste 2b Tupelo MS 38804-4017 Ph: (662) 471-4055 |
| NPI Number | 1356175426 |
|---|---|
| Provider Enumeration Date | 08/29/2024 |
| Last Update Date | 08/29/2024 |
| Certification Date | 08/29/2024 |
| Medicare PECOS PAC ID | 6305378860 |
|---|---|
| Medicare Enrollment ID | O20241022002760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356175426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Liria S Peshkepia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245838143 PECOS PAC ID: 1759813215 Enrollment ID: I20241022003016 |
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