Live Oak Psychological Associtaes
NPI 1750577805ActiveOrganization· Psychologist, Clinical· Jackson, MS
Psychologist, Clinical in Jackson, Mississippi, registered in NPPES in September 2007. The authorized official on file is Lisa Halderman Dieth, Office Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1750577805 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 22, 2007 |
| Last updated in NPPES | Sep 22, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MS) |
|---|
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