FAIR PARK COUNSELING PLLC NPI 1730661331

NPI Information

FAIR PARK COUNSELING PLLC is a rehabilitation and substance use disorder clinic center in Tupelo, MS. FAIR PARK COUNSELING PLLC NPI is 1730661331. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

210 E MAIN ST STE 2C
TUPELO, MS
ZIP 38804-017
Phone: (662) 760-0052
Fax: (662) 495-4080

The provider's authorized official is Kelly W Ferguson .
The authorized official title is Ceo and has the following contact phone number (662) 760-0052.

The CLIA number assigned to this NPI record is 25D2190688 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/30/2018 and was last updated on 11/7/2021.

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:

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