DR. JOHN STEPHEN SOUTHERN EDD NPI 1396084786

NPI Information

NPI: 1396084786
Provider Name: DR. JOHN STEPHEN SOUTHERN, EDD
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
106 SUGALOCH CV
JACKSON, MS
ZIP 39211
Phone: (618) 762-0303
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DR. John Stephen Southern, EDD is a professional counselor in Jackson, MS. DR. John Stephen Southern, EDD NPI is 1396084786. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

106 SUGALOCH CV
JACKSON, MS
ZIP 39211-435
Phone: (618) 762-0303

The enumeration date for this NPI number is 2/6/2013 and was last updated on 4/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103T00000X	Psychologist		071009636	ILLINOIS	No
2	106H00000X	Marriage & Family Therapist		T0188	MISSISSIPPI	No
3	101YP2500X	Counselor	Professional	0571	MISSISSIPPI	Yes
4	101YP2500X	Counselor	Professional	08559	TEXAS	No
5	103T00000X	Psychologist		003695	PENNSYLVANIA	No
6	103T00000X	Psychologist		30540	CALIFORNIA	No
7	103T00000X	Psychologist		071.009636	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	30540	OTHER	CALIFORNIA	PSYCHOLOGIST LICENSE
2	0571	OTHER	MISSISSIPPI	PROFESSIONAL COUNSELOR LICENSE
3	071.009636	OTHER	ILLINOIS	CLINICAL PSYCHOLOGIST LICENSE
4	PS-003695-L	OTHER	PENNSYLVANIA	PSYCHOLOGIST LICENSE
5	0571	OTHER	TEXAS	PROFESSIONAL COUNSELOR LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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