Latonya Polk, CMHT

Key facts

NPI

1821603705

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

Practice address

460 Briarwood Dr Ste 510
Jackson, MS 39206-3057

Phone

(601) 956-4816

Fax

(601) 956-4817

NPI assigned

Sep 9, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 9, 2020.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1821603705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13509",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392363509",
            "telephone_number": "601-956-4816",
            "fax_number": "601-956-4817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 BRIARWOOD DR STE 510",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063057",
            "telephone_number": "601-956-4816",
            "fax_number": "601-956-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "LATONYA",
        "credential": "CMHT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01670076",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Jackson",
            "affiliation": "N",
            "endpointDescription": "JACKSON",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Jackson",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Jackson",
            "address_1": "460 Briarwood Dr Ste 510",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392063057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Aaron William Plunkett
• Podiatry Associates of Central Mississippi
• Polk Rehabilitation Services, Inc.
• Jo Lynn Polk, M.D.
• Polk'S Crossgates Discount Drugs Inc.
• Katherine Pollan
• J. Daryl Pollard, M.D.
• Jasmine Pollard
• Jim H Polles, D.M.D.

All providers in Jackson, MS · Mental Health Counselor in Mississippi