Active NPI
Herman Island
- Counselor
- Tunica, MS
National Provider Identifier
1700701547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1017 Abbay St Apt C2
Tunica, MS 38676-9324 - Phone
- (662) 613-9199
- NPI assigned
- Aug 11, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MS | Primary |
Addresses
Primary practice location
1017 Abbay St Apt C2
Tunica, MS 38676-9324
Mailing address
1017 Abbay St Apt C2
Tunica, MS 38676-9324
Phone (662) 613-9199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786406400000",
"number": "1700701547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 ABBAY ST APT C2",
"city": "TUNICA",
"state": "MS",
"postal_code": "386769324",
"telephone_number": "662-613-9199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 ABBAY ST APT C2",
"city": "TUNICA",
"state": "MS",
"postal_code": "386769324",
"telephone_number": "662-613-9199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISLAND",
"first_name": "HERMAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-08-11",
"last_updated": "2026-08-11",
"certification_date": "2026-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MS",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tunica, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.