Healthcare Provider Details

I. General information

NPI: 1336424589
Provider Name (Legal Business Name): REGION IV MENTAL HEALTH SERVICES-ALCORN CHILDREN'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 S HARPER RD
CORINTH MS
38834-6723
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4055
  • Fax: 662-287-4114
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON RAMEY
Title or Position: INTERIM DIRECTOR
Credential:
Phone: 662-286-9883