Southern Serenity Counseling, LLC
Organization Active NPI Counselor · Hernando, MS
NPI 1396562716 · NPPES record last updated Sep 25, 2024
Key facts
- NPI
- 1396562716
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counselor 101Y00000X
- Legal business name
- SOUTHERN SERENITY COUNSELING, LLC
- Practice address
- 1579 Cedar Lake Cir
Hernando, MS 38632-6955 - Phone
- (662) 614-0719
- NPI assigned
- Sep 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Laurie Cooper, LPC
- Title
- Owner, Counselor
- Phone
- (662) 614-0719
Practitioners 1
-
Laurie Bankston, M.ED.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260108002681 | MS | Part B Supplier - Clinic/Group Practice | 4880170919 |
Receives reassigned benefits from 1 practitioner Practice locations: Hernando, MS |
National Provider Directory
Locations
2446 Caffey St
Ste 2A
Hernando, MS 38632
Phone (205) 901-8622
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | Yes |
Addresses
Primary practice location
1579 Cedar Lake Cir
Hernando, MS 38632-6955
Mailing address
1579 Cedar Lake Cir
Hernando, MS 38632-6955
Phone (662) 614-0719
Other providers in Hernando, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.