Jaqueline Tolleson Carter, LPC/MHSP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1733 Issued in MS

Practice address

1045 Church Rd E Ste 2
Southaven, MS 38671-9702

Phone

(662) 235-9063

Fax

(662) 536-7439

NPI assigned

Oct 25, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jaqueline Tareas Tolleson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1629321815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 CHURCH RD E STE 2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719702",
            "telephone_number": "662-235-9063",
            "fax_number": "662-536-7439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 CHURCH RD E STE 2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719702",
            "telephone_number": "662-235-9063",
            "fax_number": "662-536-7439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6858 Swinnea Rd",
            "address_2": "4 Rutland Pl",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386719493",
            "country_code": "US",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARTER",
        "first_name": "JAQUELINE",
        "middle_name": "TOLLESON",
        "name_prefix": "Mrs.",
        "credential": "LPC/MHSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-25",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "1733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAQUELINE",
            "last_name": "TOLLESON",
            "middle_name": "TAREAS",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carnahan Clinic PLLC
• Walter Earl Carnahan, DO
• Donnielle Carney, NP
• Julie J Carpenter, MD
• Gary Dwain Carr, MD
• Marlee Carter, SLP
• Rachel Shea Carter, PTA
• Abigail Yocasta Casey, LPC
• Ruth Ouzts Cash, PH.D., NCC, LPC
• John Catafygoitu, D.P.M.

• All providers in Southaven, MS
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.