Healthcare Provider Details

I. General information

NPI: 1558062604
Provider Name (Legal Business Name): PRISM MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 ROBINSON ST
OCEAN SPRINGS MS
39564-3841
US

IV. Provider business mailing address

1101 ROBINSON ST
OCEAN SPRINGS MS
39564-3841
US

V. Phone/Fax

Practice location:
  • Phone: 601-283-8038
  • Fax: 228-256-6075
Mailing address:
  • Phone: 228-707-1101
  • Fax: 228-220-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY BAKER
Title or Position: MEMBER LLC, BUSINESS ADMIN
Credential:
Phone: 228-860-6812