Healthcare Provider Details

I. General information

NPI: 1497156384
Provider Name (Legal Business Name): HINDS BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HIGHWAY 80 W
JACKSON MS
39209-7201
US

IV. Provider business mailing address

3450 HIGHWAY 80 W
JACKSON MS
39209-7201
US

V. Phone/Fax

Practice location:
  • Phone: 601-321-2400
  • Fax: 601-321-2476
Mailing address:
  • Phone: 601-321-2400
  • Fax: 601-321-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2054
License Number StateMS

VIII. Authorized Official

Name: LATORIA MILLER
Title or Position: BILLER/CREDENTIAL SPECIALIST
Credential:
Phone: 601-321-2497