NPIMap

Organization Active NPI

Premier Professional Counseling Services, LLC

  • Clinical Social Worker
  • Gulfport, MS
National Provider Identifier
1750878781
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C6462 Issued in MS
Legal business name
PREMIER PROFESSIONAL COUNSELING SERVICES, LLC
Practice address
1390 29TH Ave Ste B
Gulfport, MS 39501-1945
Phone
(228) 220-4226
Fax
(228) 220-4303
NPI assigned
Apr 16, 2018
Last updated
Apr 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

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

Authorized official

Name
Jocelyn Gavin-Lane, LCSW, MPHNPI 1033158936
Title
Owner
Phone
(228) 220-4226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C6462 MS Primary

Addresses

Primary practice location

1390 29TH Ave Ste B
Gulfport, MS 39501-1945

Mailing address

PO Box 10743
Gulfport, MS 39505-0743
Phone (228) 220-4226

Other identifiers 1

IdentifierTypeStateIssuer
05525369MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220121001016 MS Part B Supplier - Clinic/Group Practice 7214329358 Receives reassigned benefits from 9 practitioners
Practice locations: Gulfport, MS

National Provider Directory

National Provider Directory

Locations

2715 Bullis Ave
Gulfport, MS 39501
Phone (228) 220-4226

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1750878781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10743",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395050743",
            "telephone_number": "228-220-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 29TH AVE STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395011945",
            "telephone_number": "228-220-4226",
            "fax_number": "228-220-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PROFESSIONAL COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "GAVIN-LANE",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-220-4226",
        "authorized_official_credential": "LCSW, MPH"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C6462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05525369",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.