PSYCHOSOCIAL BOUTIQUE, PLLC. (NPI# 1841846904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841846904 |
| Entity Type | Organization |
| Organization Name | PSYCHOSOCIAL BOUTIQUE, PLLC. |
| Practice Address |
1321 Sunset Dr Ste N Grenada MS 38901-4007 |
| Practice Telephone | 6627927222 |
| Practice Fax Number | 6622267282 |
| Mailing Telephone | 6627927222 |
| Mailing Fax Number | 6622267282 |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2020-10-26 |
| Authorized Official Name | SYRENIA JOHNSON (OWNER/PRACTITIONER) |
| Authorized Official Telephone | 6627927222 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1360 Sunset Dr Ste 13a, Grenada, MS 389012857 | 6627927222 | 6622267282 |
| Street Address |
1321 SUNSET DR STE N |
| City | GRENADA |
| State | MS |
| Zip Code | 38901-4007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902435118 | The Mane Physician | Prosthetic/Orthotic Supplier | 94 Spain Drive, Grenada, MS 38901 | 2020-04-08 |
| 1942842166 | Sylvia C Bass | Technician | 813 Union Street, Grenada, MS 38901 | 2019-10-09 |
| 1669971180 | Jenny Taylor | Nurse Practitioner | 350 Sunset Drive, Grenada, MS 38901 | 2018-02-10 |
| 1073912762 | John Thomas Mcree I | Counselor | 2026 Commerce St Ste 8e, Grenada, MS 38901 | 2014-08-19 |
| 1700213634 | State of Mississippi-university of Mississippi Medical Center | Home Health | 960 Avent Drive, Grenada, MS 38901 | 2013-10-10 |
| 1114359866 | Cmhp Enterprises | Dentist | 1420 Wooded Drive, Grenada, MS 38901 | 2013-08-05 |
| 1518256460 | Mercy Hospice LLC | Hospice Care, Community Based | 1410 Wooded Drive, Grenada, MS 38901 | 2011-03-31 |
| 1215256318 | Della Lea Welsh | Speech-Language Pathologist | 1321 Dd Sunset Dr., Grenada, MS 38901 | 2010-05-28 |
| 1750514543 | Family Health Care Clinic, Inc. | Clinic/Center | 1102 Telegraph St, Grenada, MS 38901 | 2009-08-27 |
| 1033384771 | Jason K Bennett | Pharmacist | 140 Shadow Wood Cv, Grenada, MS 38901 | 2008-04-24 |
| Find all providers in zip 38901 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205436003 | Sessoms Therapeutic Counseling and Consulting Services, LLC | Clinic/Center | 232 Market St Ofc 230, Flowood, MS 39232-3339 | 2020-10-29 |
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1336753201 | Feelings Matter Counseling Services LLC | Clinic/Center | 2144 Second St, Natchez, MS 39120-2767 | 2020-09-08 |
| 1679185136 | Where Positivity Grows | Clinic/Center | 121 Hanover St, Madison, MS 39110-6028 | 2020-08-17 |
| 1750908182 | Horizon Connections | Clinic/Center | 1818 Crane Ridge Dr Ste 101, Jackson, MS 39216-4912 | 2020-07-01 |
| 1003432626 | Positive Innergy Counseling Services, LLC | Clinic/Center | 6562 King Rd, Meridian, MS 39305-8364 | 2020-06-19 |
| 1548894488 | Day To Day Counseling and Consulting | Clinic/Center | 1389 Cliff Gookin Blvd Ste D, Tupelo, MS 38801-6458 | 2020-03-01 |
| 1174157689 | Sound Mind Psychiatry Pllc | Clinic/Center | 105 W Hamilton St, Houston, MS 38851-2209 | 2020-02-24 |
| 1427693944 | Green Spot Wellbeing LLC | Clinic/Center | 100 Front Ave, Indianola, MS 38751-2461 | 2019-11-07 |
| 1164071981 | Community Care Group LLC | Clinic/Center | 54 E Franklin St, Natchez, MS 39120-3665 | 2019-09-04 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PSYCHOSOCIAL BOUTIQUE, 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.