Provider Demographics
NPI:1104079870
Name:HONOR THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:HONOR THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:601-624-2043
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MS
Mailing Address - Zip Code:39175-0091
Mailing Address - Country:US
Mailing Address - Phone:601-624-2043
Mailing Address - Fax:601-885-2060
Practice Address - Street 1:1308 BARLOW DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MS
Practice Address - Zip Code:39175-9423
Practice Address - Country:US
Practice Address - Phone:601-624-2043
Practice Address - Fax:601-885-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0346261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1629150222OtherNPPES
MS00118814Medicaid