Provider Demographics
NPI:1447892161
Name:UNIQUELY YOURS LIFE SOLUTIONS, LLC
Entity type:Organization
Organization Name:UNIQUELY YOURS LIFE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S
Authorized Official - Phone:769-218-4013
Mailing Address - Street 1:505 FLEETWOOD CV
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-8708
Mailing Address - Country:US
Mailing Address - Phone:769-218-4013
Mailing Address - Fax:769-235-1020
Practice Address - Street 1:232 MARKET ST
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3339
Practice Address - Country:US
Practice Address - Phone:769-218-4013
Practice Address - Fax:769-235-1020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WANDA R. HARRIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07350300Medicaid