Healthcare Provider Details

I. General information

NPI: 1609562586
Provider Name (Legal Business Name): ELY PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N PEARMAN AVE
CLEVELAND MS
38732-2633
US

IV. Provider business mailing address

PO BOX 520
MARION MS
39342-0520
US

V. Phone/Fax

Practice location:
  • Phone: 662-390-6244
  • Fax: 949-561-4976
Mailing address:
  • Phone: 601-646-7700
  • Fax: 888-735-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY CAY BROOKS ELY
Title or Position: OWNER
Credential: PMHNP-B.C.
Phone: 601-646-7800