Healthcare Provider Details

I. General information

NPI: 1093662447
Provider Name (Legal Business Name): MAITRI MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 GROVELAND RD STE A
OCEAN SPRINGS MS
39564-5768
US

IV. Provider business mailing address

3670 GROVELAND RD STE A
OCEAN SPRINGS MS
39564-5768
US

V. Phone/Fax

Practice location:
  • Phone: 228-365-3191
  • Fax: 228-875-9065
Mailing address:
  • Phone: 228-365-3191
  • Fax: 228-875-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MOIRA ANDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 228-365-3191