| Salt And Light Counseling Llc | |
|
232 Goodman Road Suite 305 Southaven MS 38671 | |
| (662) 571-5539 | |
| Not Available |
| Full Name | Salt And Light Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 232 Goodman Road, Southaven, Mississippi |
| Authorized Official Name and Position | Jeremy Erickson (THERAPIST) |
| Authorized Official Contact | 6628569563 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salt And Light Counseling Llc 232 Goodman Road Suite 305 Southaven MS 38671 Ph: () - | Salt And Light Counseling Llc 232 Goodman Road Suite 305 Southaven MS 38671 Ph: (662) 571-5539 |
| NPI Number | 1356104004 |
|---|---|
| Provider Enumeration Date | 02/05/2024 |
| Last Update Date | 04/03/2024 |
| Certification Date | 04/03/2024 |
| Medicare PECOS PAC ID | 8628500444 |
|---|---|
| Medicare Enrollment ID | O20241018000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356104004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jeremy Erickson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396225504 PECOS PAC ID: 9537691357 Enrollment ID: I20241018000299 |
| Provider Name | Denise Fowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326125931 PECOS PAC ID: 3072683374 Enrollment ID: I20241107004191 |
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