Healthcare Provider Details

I. General information

NPI: 1083160782
Provider Name (Legal Business Name): CHANDRA SUMLIN-BROWN DBA SUMLIN BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8237B OKATIBBEE DAM ROAD
COLLINSVILLE MS
39325
US

IV. Provider business mailing address

8237B OKATIBBEE DAM ROAD
COLLINSVILLE MS
39325
US

V. Phone/Fax

Practice location:
  • Phone: 601-480-6232
  • Fax:
Mailing address:
  • Phone: 601-480-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberR886070
License Number StateMS

VIII. Authorized Official

Name: MRS. CHANDRA RENAE SUMLIN-BROWN
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 601-480-6232