Healthcare Provider Details

I. General information

NPI: 1063847200
Provider Name (Legal Business Name): REGION IV MENTAL HEALTH SERVICES-NFUSION OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 HIGHWAY 72 E ANX
CORINTH MS
38834-8800
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-2152
  • Fax: 662-287-2070
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLIE SPEARMAN SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-286-9883