| Prism Online Therapy, Llc | |
|
1221 Wellington Ln Ocean Springs MS 39564-3209 | |
| (601) 283-8038 | |
| Not Available |
| Full Name | Prism Online Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1221 Wellington Ln, Ocean Springs, Mississippi |
| Authorized Official Name and Position | Alvin M Baker (OWNER/LCSW) |
| Authorized Official Contact | 2288608824 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prism Online Therapy, Llc Po Box 1087 Biloxi MS 39533-1087 Ph: () - | Prism Online Therapy, Llc 1221 Wellington Ln Ocean Springs MS 39564-3209 Ph: (601) 283-8038 |
| NPI Number | 1558062604 |
|---|---|
| Provider Enumeration Date | 03/15/2023 |
| Last Update Date | 03/15/2023 |
| Certification Date | 03/15/2023 |
| Medicare PECOS PAC ID | 1557718574 |
|---|---|
| Medicare Enrollment ID | O20231114000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558062604 | NPI | - | NPPES |
| Provider Name | Alvin Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598210882 PECOS PAC ID: 7214357938 Enrollment ID: I20201020000056 |
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