Most Relevant Information
Provider Data
| NPI Number: | 1003587486 |
| Provider Name: | KIMBERLY ELAM SALLIS PHD; LPC-S, BC-TMH |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 0933 |
Most Important Dates
| Enumeration Date: | 09/24/2021 |
| Last Updated: | 09/24/2021 |
Provider Practice Location
507 HERITAGE DR STE 102
OXFORD
MS
386555571
Practice Location Phone/Fax
| Phone: | 6628160968 |
| Fax: |
Provider Mailing Location
558 COUNTY ROAD 102
OXFORD
MS
386558610
Provider Mailing Phone/Fax
| Phone: | 6628160968 |
| Fax: |