Shine Pediatric Psychology Services PLLC
Clinic/Center, Adolescent and Children Mental Health in Meridian, MS. Organization (NPI-2).
NPI number1982321964
StatusActive
Last updated in NPPESOct 20, 2022
Details
- NPI
- 1982321964
- Entity type
- Organization (NPI-2)
- Legal business name
- Shine Pediatric Psychology Services PLLC
- Organization subpart
- No
- Enumeration date
- Oct 20, 2022
- Certification date
- Oct 20, 2022
- Last updated
- Oct 20, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – | Yes |
Practice location
2449 N Park Dr Ste CMeridian, MS 39305-2669
Phone 601-282-5250 · Fax 601-286-5305
Mailing address
2449 N Park Dr Ste CMeridian, MS 39305-2669
Phone 601-282-5250 · Fax 601-286-5305
Authorized official
Michelle Boucher-Snodgrass
Licensed Psychologist/Owner
6012825250
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