Healthcare Provider Details

I. General information

NPI: 1932995586
Provider Name (Legal Business Name): USDR BEHAVIORAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CLINTON BLVD STE F
CLINTON MS
39056-5254
US

IV. Provider business mailing address

114 OAKHURST DR
CLINTON MS
39056-3120
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-4837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: UDARIKA ROSS
Title or Position: EXECUTIVE DIRECTOR/ OWNER
Credential:
Phone: 601-720-4837