Healthcare Provider Details

I. General information

NPI: 1164853206
Provider Name (Legal Business Name): HINDS BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
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: 601-321-2497
  • Fax: 601-321-2476
Mailing address:
  • Phone: 601-321-2497
  • Fax: 601-321-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1827
License Number StateMS

VIII. Authorized Official

Name: LATORIA MILLER
Title or Position: INSURANCE CLERK/CREDENITAL SPECIALI
Credential:
Phone: 601-321-2497