1184251555 NPI number — YASMEEN PATRICIA EICHELBERGER LCSW

Table of content: YASMEEN PATRICIA EICHELBERGER LCSW (NPI 1184251555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184251555 NPI number — YASMEEN PATRICIA EICHELBERGER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EICHELBERGER
Provider First Name:
YASMEEN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1184251555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4226 SUMMERTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRAM
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39272-8738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-248-7561
Provider Business Mailing Address Fax Number:
855-387-8203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 GEORGE ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39202-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-248-7561
Provider Business Practice Location Address Fax Number:
855-387-8203
Provider Enumeration Date:
03/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C5009 , 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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