Provider Demographics
NPI:1700319068
Name:PROSPERITY COUNSELING SERVICE LLC
Entity type:Organization
Organization Name:PROSPERITY COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:601-942-1884
Mailing Address - Street 1:252 CALLAWAY CIR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-4521
Mailing Address - Country:US
Mailing Address - Phone:601-942-1884
Mailing Address - Fax:
Practice Address - Street 1:2627 RIDGEWOOD RD
Practice Address - Street 2:STE 103
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4904
Practice Address - Country:US
Practice Address - Phone:601-942-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty