Healthcare Provider Details

I. General information

NPI: 1669499687
Provider Name (Legal Business Name): REGION ONE MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 CHERYL ST
CLARKSDALE MS
38614-7218
US

IV. Provider business mailing address

PO BOX 1046
CLARKSDALE MS
38614-1046
US

V. Phone/Fax

Practice location:
  • Phone: 662-627-7267
  • Fax: 662-627-5240
Mailing address:
  • Phone: 662-627-7267
  • Fax: 662-627-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberMDMH CERTIFIED
License Number StateMS

VIII. Authorized Official

Name: MRS. KAREN B CORLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-627-7267