Provider Demographics
NPI:1306572235
Name:FPC INTENSIVE OUTPATIENT PROGRAM
Entity type:Organization
Organization Name:FPC INTENSIVE OUTPATIENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-871-6657
Mailing Address - Street 1:210 E MAIN ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-760-0052
Mailing Address - Fax:662-495-4080
Practice Address - Street 1:210 E MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-760-0052
Practice Address - Fax:662-495-4080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIR PARK COUNSELING PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty