Destination Life LLC-S

Organization Active
NPI 1023625894
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Ellisville, MS

Destination Life LLC-S is a child & adolescent psychiatric/mental health clinical nurse specialist located in Ellisville, MS. The NPI was issued on September 25, 2020, and the record was last updated in NPPES on July 30, 2021. The record lists 15 taxonomy codes. One additional practice location is listed.

This record hasn't been updated in NPPES since 2021. Details may be out of date.

Taxonomies and licenses

TaxonomyCodeLicense
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Primary 364SP0807X Not listed
Clinical Social Worker 1041C0700X Not listed
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X Not listed
Occupational Therapist 225X00000X Not listed
Mental Health Occupational Therapist 225XM0800X Not listed
Primary Care Clinic/Center 261QP2300X Not listed
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Not listed
Clinical Medical Laboratory 291U00000X Not listed
Nurse Practitioner 363L00000X Not listed
Community Health Nurse Practitioner 363LC1500X Not listed
Family Nurse Practitioner 363LF0000X Not listed
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Not listed
Women's Health Nurse Practitioner 363LW0102X Not listed
Clinical Nurse Specialist 364S00000X Not listed
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X Not listed

Practice locations

7 Jonathan Way
Ellisville, MS 39437-5195
Phone: (817) 473-1312
1759 Broad Park Cir S Ste 113
Mansfield, TX 76063-7836
Phone: (817) 473-1312

Local context

Active NPPES records list 1 provider with child & adolescent psychiatric/mental health clinical nurse specialist as the primary taxonomy within 25 miles of this practice location's ZIP code.

The same primary taxonomy is listed by 1 in Mississippi and 257 nationwide.

These are counts from NPPES records, not a ranking or recommendation. Distances are measured between ZIP code centers, not street addresses.

Record history

Status
Active
NPI issued
Last updated in NPPES

Is this your record? Updates are made through NPPES, the official National Plan and Provider Enumeration System.

NPPES data as of · Source: CMS NPPES

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