Delta Life Therapeutic Solutions PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

DELTA LIFE THERAPEUTIC SOLUTIONS PLLC

Doing business as

Delta Life Therapeutic Solutions PLLC

Practice address

705 1/2 Cleveland St
Itta Bena, MS 38941

Phone

(662) 458-0408

NPI assigned

Jan 4, 2021

Organization subpart

No

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

Authorized official

Name

Emelja QuinnNPI 1821754607

Title

Ceo

Phone

(662) 458-0408

Specialties & licenses 1

Addresses

Other names 1

• Delta Life Therapeutic Solutions PLLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Emelja Quinn, MSW,CMHT

  • Mental Health Counselor
  • Greenwood, MS
  • NPI 1821754607
  NPD Authorized official

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1124616354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 CLEVELAND ST",
            "city": "ITTA BENA",
            "state": "MS",
            "postal_code": "389412603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 1/2 CLEVELAND ST",
            "city": "ITTA BENA",
            "state": "MS",
            "postal_code": "38941",
            "telephone_number": "662-458-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA LIFE THERAPEUTIC SOLUTIONS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2020-12-25",
        "status": "A",
        "authorized_official_last_name": "QUINN",
        "authorized_official_first_name": "EMELJA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-458-0408"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Life Therapeutic Solutions PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Itta Bena, MS
• Providers in Itta Bena, MS by specialty
• Community/Behavioral Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.