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NPI Code Detail

MEDICARE: THOMAS PRUDE PCMHT

MEDICARE: THOMAS PRUDE PCMHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1770716508
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS PRUDE PCMHT
Provider Business Mailing Address
First Line : 3450 HIGHWAY 80 W
Second Line :
City : JACKSON
State : MS
Zip : 39209-7201
Country : US
Telephone Number : 601-321-2400
Fax Number :
Provider Business Practice Location Address
First Line : 3450 HIGHWAY 80 W
Second Line :
City : JACKSON
State : MS
Zip : 39209-7201
Country : US
Telephone Number : 601-321-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2009
Last Update Date : 09/20/2019

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Directions to “ THOMAS PRUDE PCMHT” Practice Location

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