Healthcare Provider Details

I. General information

NPI: 1902729114
Provider Name (Legal Business Name): ELITE CARE MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 TEAL DR
BYRAM MS
39272-5681
US

IV. Provider business mailing address

5319 TEAL DR
BYRAM MS
39272-5681
US

V. Phone/Fax

Practice location:
  • Phone: 662-299-4140
  • Fax:
Mailing address:
  • Phone: 662-299-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DEMETRICE DOTSON-IRVIN
Title or Position: CEO
Credential:
Phone: 662-299-4140