| NPI | 1073988051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA E. KILLEBREW Clinical Psychologist 601-750-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 54946) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MS 54946) |
| 302R00000X Health Maintenance Organization (Licence: MS 54946) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2022-02-03 |