Healthcare Provider Details

I. General information

NPI: 1790802908
Provider Name (Legal Business Name): JULIE ROSS, NP, PLLC DBA BROOKHAVEN NEUROBEHAVIORAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHWAY 51 S
BROOKHAVEN MS
39601-3245
US

IV. Provider business mailing address

215 HIGHWAY 51 S
BROOKHAVEN MS
39601-3245
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-0895
  • Fax: 601-835-0610
Mailing address:
  • Phone: 601-833-0895
  • Fax: 601-835-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC0969
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR672718
License Number StateMS

VIII. Authorized Official

Name: MS. RAMONA M CAMBELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-833-0895