FAIR PARK COUNSELING PLLC (NPI# 1730661331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730661331 |
| Entity Type | Organization |
| Organization Name | FAIR PARK COUNSELING PLLC |
| Practice Address |
210 E Main St Ste 2c Tupelo MS 38804-4017 |
| Practice Telephone | 6627600052 |
| Mailing Telephone | 6627600052 |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |
| Authorized Official Name | MR. KELLY W FERGUSON (PRESIDENT) |
| Authorized Official Telephone | 6627600052 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
210 E MAIN ST STE 2C |
| City | TUPELO |
| State | MS |
| Zip Code | 38804-4017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376175521 | James Edwin Blackmon | Counselor | 210 E Main St Ste 2c, Tupelo, MS 38804-4017 | 2020-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1134762784 | Kimberly J Adams | Occupational Therapy Assistant | 90 Clark Ave, Tupelo, MS 38804 | 2019-10-25 |
| 1790270924 | Megan Guntharp | Occupational Therapist | 960 Commonwealth Boulevard, Tupelo, MS 38804 | 2018-06-29 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1790235919 | Dr Scott Dickinson D.m. D. PC | Dentist | 3999 N Gloster Street, Tupelo, MS 38804 | 2016-10-12 |
| 1326496621 | Angela Estes | Occupational Therapist | County Road 1279 House#197, Tupelo, MS 38804 | 2016-05-26 |
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1104238898 | Stella M. Johnson | Social Worker | 2292 Camelot Cir, Tupelo, MS 38804 | 2014-05-29 |
| 1821437351 | Lenka Petersen | Student in an Organized Health Care Education/Training Program | 1665 S Green St., Nmmc, Tupelo, MS 38804 | 2013-06-18 |
| 1083966303 | Jessica M Baskett | Counselor | 398 E Main St, Tupelo, MS 38804 | 2012-10-10 |
| Find all providers in zip 38804 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356757678 | Mae Grace Arrington | Counselor | 4428 S Eason Blvd Ste B, Tupelo, MS 38801-6506 | 2014-07-08 |
| 1871684167 | Deborah Ann Lankford | Counselor | Region IIi Mental Health Center-cds, 920 Boone Street, Tupelo, MS 38804 | 2006-09-28 |
| 1902997281 | Amelia T Ladreyt | Counselor | Region IIi Mental Health-chemical Depency Services, 920 Boone Street, Tupelo, MS 38804 | 2006-09-28 |
| 1619068996 | Danny B Mcbrayer | Counselor | Region IIi Mental Health-chemical Dependency Services, 920 Boone Street, Tupelo, MS 38804 | 2006-09-28 |
| 1730280397 | Vernard R Jones | Counselor | 920 Boone St, Tupelo, MS 38804-5908 | 2006-09-26 |
| 1114554912 | Micheal Byles | Counselor | 2434 S Eason Blvd, Tupelo, MS 38804-6942 | 2020-03-24 |
| 1588203798 | Christy Lindsey | Counselor | 2434 S Eason Blvd, Tupelo, MS 38804-6942 | 2020-01-06 |
| 1447775879 | Clint Crawford | Counselor | 920 Boone St, Tupelo, MS 38804-5908 | 2017-08-07 |
| 1225444573 | Patricia Baggett | Counselor | 4579 S Eason Blvd, Tupelo, MS 38801-6539 | 2014-07-08 |
| 1659797819 | Porter Mckee | Counselor | 341 E Main St, A-1, Tupelo, MS 38804-4025 | 2014-03-12 |
| Find all providers in TUPELO | ||||
Please comment or provide details below to improve the information on FAIR PARK COUNSELING PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.