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4005 N State St Ste N Jackson MS 39206-5755 | |
| (601) 506-8735 | |
| (601) 767-2747 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4005 N State St Ste N, Jackson, Mississippi |
| Authorized Official Name and Position | Nanetta Payne (FOUNDER/PRESIDENT) |
| Authorized Official Contact | 6015068735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4005 N State St Ste N Jackson MS 39206-5755 Ph: (601) 506-8735 | 4005 N State St Ste N Jackson MS 39206-5755 Ph: (601) 506-8735 |
| NPI Number | 1215375746 |
|---|---|
| Provider Enumeration Date | 06/06/2013 |
| Last Update Date | 06/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215375746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 48841 (Mississippi) | Primary |
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