Kimberly Elam Sallis, PHD; LPC-S, BC-TMH

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0933 Issued in MS

Practice address

507 Heritage Dr Ste 102
Oxford, MS 38655-5571

Phone

(662) 816-0968

NPI assigned

Sep 24, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1003587486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 COUNTY ROAD 102",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386558610",
            "telephone_number": "662-816-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 HERITAGE DR STE 102",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555571",
            "telephone_number": "662-816-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLIS",
        "first_name": "KIMBERLY",
        "middle_name": "ELAM",
        "name_prefix": "Dr.",
        "credential": "PHD; LPC-S, BC-TMH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-24",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "0933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kimberly.sallisphd@nexxusms.com",
            "affiliation": "N",
            "address_1": "507 Heritage Dr Ste 102",
            "city": "Oxford",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386555571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Professional Counselor in Oxford, MS
• Providers in Oxford, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.