Healthcare Provider Details

I. General information

NPI: 1609669365
Provider Name (Legal Business Name): BRAIN GROUP AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 DELAWARE AVE
MCCOMB MS
39648-4025
US

IV. Provider business mailing address

608 DELAWARE AVE
MCCOMB MS
39648-4025
US

V. Phone/Fax

Practice location:
  • Phone: 601-324-3109
  • Fax: 601-324-3105
Mailing address:
  • Phone: 601-324-3109
  • Fax: 601-324-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK MCNEIL
Title or Position: OWNER
Credential:
Phone: 601-376-6247