1891169306 NPI number — F.C. OF MISSISSIPPI, INC.

Table of content: SARAH JEAN RICHARDS LCSW (NPI 1700502556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891169306 NPI number — F.C. OF MISSISSIPPI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
F.C. OF MISSISSIPPI, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891169306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 KELLER SPRINGS RD STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-5911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-442-0967
Provider Business Mailing Address Fax Number:
214-445-3994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 FERNCLIFF DRIVE
Provider Second Line Business Practice Location Address:
SUTIES 1 & 3
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-393-0109
Provider Business Practice Location Address Fax Number:
662-393-4306
Provider Enumeration Date:
11/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NIX
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
214-445-3750

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7294 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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