| Psychosocial Boutique, Pllc. | |
|
1330 Sunset Dr Grenada MS 38901-4000 | |
| (662) 892-2660 | |
| (662) 892-2660 |
| Full Name | Psychosocial Boutique, Pllc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1330 Sunset Dr, Grenada, Mississippi |
| Authorized Official Name and Position | Syrenia Leslie Winters (OWNER/PRACTITIONER) |
| Authorized Official Contact | 6628922660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychosocial Boutique, Pllc. 1330 Sunset Dr Grenada MS 38901-4000 Ph: (662) 892-2660 | Psychosocial Boutique, Pllc. 1330 Sunset Dr Grenada MS 38901-4000 Ph: (662) 892-2660 |
| NPI Number | 1841846904 |
|---|---|
| Provider Enumeration Date | 08/14/2019 |
| Last Update Date | 02/22/2023 |
| Certification Date | 02/22/2023 |
| Medicare PECOS PAC ID | 7517298425 |
|---|---|
| Medicare Enrollment ID | O20191008000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841846904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Syrenia Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598113482 PECOS PAC ID: 2769713684 Enrollment ID: I20191008001049 |
Parkwood Pavilion At Grenada Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 960 Avent Dr, Grenada, MS 38901 Phone: 662-227-7000 Fax: 662-227-7534 | |
The Premier Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 983 S Line St, Grenada, MS 38901 Phone: 662-809-3794 Fax: 662-226-3794 | |
Viner Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Southwest Frontage Rd, Grenada, MS 38901 Phone: 662-226-3762 | |
Kasp Consulting Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 960 Avent Dr, Umc Grenada Senior Care Unit, Grenada, MS 38901 Phone: 662-227-6528 | |
Karen Plunkett, M.d.pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1300 Sunset Dr Ste O, Grenada, MS 38901 Phone: 662-227-0998 Fax: 662-227-0984 |