Healthcare Provider Details

I. General information

NPI: 1902578982
Provider Name (Legal Business Name): MIND WORKS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MORRIS GREEN RD
LUCEDALE MS
39452-2689
US

IV. Provider business mailing address

301 MORRIS GREEN RD
LUCEDALE MS
39452-2689
US

V. Phone/Fax

Practice location:
  • Phone: 601-530-5287
  • Fax:
Mailing address:
  • Phone: 601-530-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FELICIA MCNEIL
Title or Position: OWNER
Credential: NP
Phone: 601-530-5287