Healthcare Provider Details

I. General information

NPI: 1699564419
Provider Name (Legal Business Name): SOUTH MISSISSIPPI MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 HOSPITAL ST
PASCAGOULA MS
39581-5320
US

IV. Provider business mailing address

PO BOX 1307
PASCAGOULA MS
39568-1307
US

V. Phone/Fax

Practice location:
  • Phone: 228-497-0690
  • Fax:
Mailing address:
  • Phone: 228-283-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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: JOSEPH MANUEL
Title or Position: MENTAL HEALTH DIRECTOR
Credential:
Phone: 228-769-3154