Fulivia Elma Cannady, MSCP,NCC,LPC
Individual provider Active NPI Counselor · Clinton, MS
NPI 1306085253 · NPPES record last updated Feb 17, 2009
Key facts
- NPI
- 1306085253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 208894 (MS)
- Practice address
- 113B Willow Brook Dr
Clinton, MS 39056-5802 - Phone
- (601) 832-8264
- NPI assigned
- Feb 17, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Impact Behavioral Counseling LLC
Practice addresses (Care Compare)
2655 Lakeland Dr
Flowood, MS 39232-9516
Phone (601) 957-7343
605 2ND Ave N
Columbus, MS 39701-4513
Phone (662) 434-4210
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250121000691 | MS | Practitioner - Mental Health Counselor | 6406385491 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 208894 | MS | MD | Counselor |
| 1220 | MS | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Behavioral Counseling LLC | Current |
Accepting new patients | |
| Pathway Healthcare- Mississippi LLC | Past |
Accepting new patients |
Locations
48 Medical Park Dr E
Ste 453
Birmingham, AL 35235
Phone (205) 517-7730
1000 Urban Center Dr
Ste 600
Vestavia, AL 35242
Phone (205) 208-0312
3600 Bluecutt Rd
Ste 202
Columbus, MS 39705
Phone (662) 434-4210
2655 Lakeland Dr
Jackson, MS 39232
Phone (601) 932-8212
1200 N State St
Ste 455
Jackson, MS 39202
Phone (601) 957-7343
5 Dunnbarr
Laurel, MS 39440
Phone (662) 434-4210
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 208894 | MS | Yes |
| Professional Counselor | 101YP2500X | 1220 | MS |
Addresses
Primary practice location
113B Willow Brook Dr
Clinton, MS 39056-5802
Mailing address
113B Willow Brook Dr
Clinton, MS 39056-5802
Phone (601) 832-8264
Other names
- Miss Fulivia Elma Banks
Other providers in Clinton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.