NPIMap

Organization Active NPI

Imani Community Center

  • Mental Health Counselor
  • Kosciusko, MS
National Provider Identifier
1740650969
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0050750 Issued in MS
Legal business name
IMANI COMMUNITY CENTER
Practice address
207 Poplar St
Kosciusko, MS 39339
Phone
(662) 803-1254
Fax
(662) 289-1010
NPI assigned
Sep 30, 2015
Last updated
Sep 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

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

Authorized official

Name
Ms. Allie G Ndiaye I, ETC.
Title
Registered Nurse
Phone
(662) 803-1254

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 0050750 MS Primary
Preferred Provider Organization 305R00000X 08533763 MS

Addresses

Primary practice location

207 Poplar St
Kosciusko, MS 39339

Mailing address

207 Poplar St
Kosciusko, MS 39090-4409
Phone (662) 633-1513

Other identifiers 3

IdentifierTypeStateIssuer
1457623118MedicaidMS
1275977357MedicaidMS
1245502962MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Imani Community Outreach Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1443571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443571200000",
    "number": "1740650969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 POPLAR ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390904409",
            "telephone_number": "662-633-1513",
            "fax_number": "662-289-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 POPLAR ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "39339",
            "telephone_number": "662-803-1254",
            "fax_number": "662-289-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMANI COMMUNITY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-30",
        "last_updated": "2015-09-30",
        "status": "A",
        "authorized_official_last_name": "NDIAYE",
        "authorized_official_first_name": "ALLIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "662-803-1254",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "ETC."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "0050750",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MS",
            "license": "08533763",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457623118",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275977357",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245502962",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; 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.