Individual provider Active NPI

Tamila Baker

  • Professional Counselor
  • Southaven, MS
National Provider Identifier
1255024162
Registry record updated Jul 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3003 Issued in MS
Practice address
1310 Goodman Rd E
Southaven, MS 38671-9542
Phone
(662) 470-5433
NPI assigned
May 29, 2023
Last updated
Jul 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3003 MS Primary

Addresses

Primary practice location

1310 Goodman Rd E
Southaven, MS 38671-9542

Mailing address

1310 Goodman Rd E
Southaven, MS 38671-9542
Phone (662) 470-5433

Other names 1

  • Tamila Brown Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jun 12, 2024 through Jun 12, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3003MSMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Brighter Days Counseling LLC Professional CurrentSince Apr 28, 2024 Accepting new patients
Soulshine Counseling and Wellness, LLC CurrentSince Jun 4, 2023 Accepting new patients

Locations

1310 Goodman Rd E
Southaven, MS 38671
Phone (662) 470-5433

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689984000000",
    "number": "1255024162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719542",
            "telephone_number": "662-470-5433",
            "fax_number": "662-536-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719542",
            "telephone_number": "662-470-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "TAMILA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-07-22",
        "certification_date": "2023-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "3003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMILA",
            "last_name": "BROWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.