| Fox & Vine, Pllc | |
|
1501 Adeline St Ste 2 Hattiesburg MS 39401-6264 | |
| (601) 255-8238 | |
| Not Available |
| Full Name | Fox & Vine, Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1501 Adeline St Ste 2, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Casey Keith (OWNER) |
| Authorized Official Contact | 6014360159 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox & Vine, Pllc 413 Mamie St Hattiesburg MS 39401-5041 Ph: (601) 436-0159 | Fox & Vine, Pllc 1501 Adeline St Ste 2 Hattiesburg MS 39401-6264 Ph: (601) 255-8238 |
| NPI Number | 1245708890 |
|---|---|
| Provider Enumeration Date | 11/12/2018 |
| Last Update Date | 11/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245708890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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