| Serenity Psychotherapy Llc | |
|
2214 25th Ave Unit 2 Gulfport MS 39501-4520 | |
| (228) 365-2317 | |
| Not Available |
| Full Name | Serenity Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2214 25th Ave Unit 2, Gulfport, Mississippi |
| Authorized Official Name and Position | Heather W Black (THERAPIST/ OWNER) |
| Authorized Official Contact | 2283652317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Psychotherapy Llc 222 Boggs Cir Long Beach MS 39560-5807 Ph: (228) 365-2317 | Serenity Psychotherapy Llc 2214 25th Ave Unit 2 Gulfport MS 39501-4520 Ph: (228) 365-2317 |
| NPI Number | 1295258101 |
|---|---|
| Provider Enumeration Date | 07/23/2017 |
| Last Update Date | 02/07/2018 |
| Medicare PECOS PAC ID | 9234402967 |
|---|---|
| Medicare Enrollment ID | O20170831002191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295258101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C5680 (Mississippi) | Primary |
| Provider Name | Heather W Black |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538491634 PECOS PAC ID: 8022250778 Enrollment ID: I20130809000316 |
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