| NPI | 1215751300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MCMANUS Billing And Credentialing Manager 601-939-5993 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-11-14 |
| Last Update Date | 2024-11-14 |