Please complete this application accurately. Incomplete applications may be denied. Attach all required documentation before submitting.
Contact:
Professional Services Licensing
Russell Kohler
RussellK@mdac.ms.gov
Phone: (662) 325-7766
Lisa Jones
LisaJ@mdac.ms.gov
Phone: (662) 325-8134
P.O. Box 5207
Mississippi State, MS 39762
Fax: (662) 325-0397

