| Premier Professional Counseling Services, Llc | |
|
1390 29th Ave Ste B Gulfport MS 39501-1945 | |
| (228) 220-4226 | |
| (228) 220-4303 |
| Full Name | Premier Professional Counseling Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1390 29th Ave Ste B, Gulfport, Mississippi |
| Authorized Official Name and Position | Jocelyn Gavin-lane (OWNER) |
| Authorized Official Contact | 2282204226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Professional Counseling Services, Llc Po Box 10743 Gulfport MS 39505-0743 Ph: (228) 220-4226 | Premier Professional Counseling Services, Llc 1390 29th Ave Ste B Gulfport MS 39501-1945 Ph: (228) 220-4226 |
| NPI Number | 1750878781 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 04/16/2018 |
| Medicare PECOS PAC ID | 7214329358 |
|---|---|
| Medicare Enrollment ID | O20220121001016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750878781 | NPI | - | NPPES |
| 05525369 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6462 (Mississippi) | Primary |
| Provider Name | Tangular Michelle Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902294093 PECOS PAC ID: 9335459122 Enrollment ID: I20151106001037 |
| Provider Name | Jocelyn Gavin-lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033158936 PECOS PAC ID: 0941692081 Enrollment ID: I20220121001070 |
| Provider Name | Riva Cornelius |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881287118 PECOS PAC ID: 3870987159 Enrollment ID: I20220302002327 |
| Provider Name | Jennifer Lynn Johnson-thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205339553 PECOS PAC ID: 3971047903 Enrollment ID: I20240702001049 |
| Provider Name | Linda Natasha Rene Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053816314 PECOS PAC ID: 1557899069 Enrollment ID: I20250113000485 |
| Provider Name | Kemberli Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134902182 PECOS PAC ID: 9032647318 Enrollment ID: I20250114003468 |
| Provider Name | Melissa M Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851160253 PECOS PAC ID: 2860922374 Enrollment ID: I20250213001857 |
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