Innovative Counseling of Mississippi, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

INNOVATIVE COUNSELING OF MISSISSIPPI, PLLC

Practice address

4780 1-55 N
Suite 100-103
Jackson, MS 39211

Phone

(601) 708-9558

NPI assigned

Mar 28, 2023

Last updated

Apr 4, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sarah Marie Pradillo, LPC

Title

Owner

Phone

(601) 708-9558

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1184328890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BELLEGROVE BLVD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4780 1-55 N",
            "address_2": "SUITE 100-103",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39211",
            "telephone_number": "601-708-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE COUNSELING OF MISSISSIPPI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-04-04",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "PRADILLO",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-708-9558",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.