Basic Information
| Provider Information | |||||||||
| NPI: | 1487325817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEAVEY | ||||||||
| FirstName: | EMMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 MILLBRANCH RD STE 40 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012555264 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32 MILLBRANCH RD | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012555264 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2021 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 21-164308 | MS | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | RBT-21-164308 | MS | Y |
No ID Information.