Healthcare Provider Details

I. General information

NPI: 1740133503
Provider Name (Legal Business Name): HARVEST AUTISM & BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 RAYNES RD
CARSON MS
39427-6366
US

IV. Provider business mailing address

338 RAYNES RD
CARSON MS
39427-6366
US

V. Phone/Fax

Practice location:
  • Phone: 601-441-4307
  • Fax: 601-441-4307
Mailing address:
  • Phone: 601-441-4307
  • Fax: 601-441-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON WILLIS
Title or Position: MANAGER
Credential:
Phone: 601-441-4307