Healthcare Provider Details

I. General information

NPI: 1417370313
Provider Name (Legal Business Name): URBAN REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HIGHWAY 80 E
CLINTON MS
39056-5244
US

IV. Provider business mailing address

PO BOX 2305
CLINTON MS
39060-2305
US

V. Phone/Fax

Practice location:
  • Phone: 601-927-0188
  • Fax: 601-292-7998
Mailing address:
  • Phone: 601-272-2202
  • Fax: 866-925-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAD09-046M
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM7217
License Number StateMS

VIII. Authorized Official

Name: MR. PHILIP B MASSEY
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, CADC II
Phone: 601-927-0188