| Soulshine Counseling And Wellness, Llc | |
|
1310 Goodman Rd E Southaven MS 38671-9542 | |
| (662) 470-5433 | |
| (501) 745-2378 |
| Full Name | Soulshine Counseling And Wellness, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1310 Goodman Rd E, Southaven, Mississippi |
| Authorized Official Name and Position | Mary Elizabeth Fox (OWNER) |
| Authorized Official Contact | 6624705433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soulshine Counseling And Wellness, Llc 1310 Goodman Rd E Southaven MS 38671-9542 Ph: (662) 470-5433 | Soulshine Counseling And Wellness, Llc 1310 Goodman Rd E Southaven MS 38671-9542 Ph: (662) 470-5433 |
| NPI Number | 1700387768 |
|---|---|
| Provider Enumeration Date | 02/26/2018 |
| Last Update Date | 09/07/2022 |
| Certification Date | 09/07/2022 |
| Medicare PECOS PAC ID | 5698020576 |
|---|---|
| Medicare Enrollment ID | O20180618001241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700387768 | NPI | - | NPPES |
| 05455768 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2143 (Mississippi) | Primary |
| Provider Name | Julie Lynnette Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710604285 PECOS PAC ID: 5294190955 Enrollment ID: I20230502001443 |
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