Healthcare Provider Details

I. General information

NPI: 1326135104
Provider Name (Legal Business Name): PSYCHIATRY ASSOCIATES OF TUPELO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 B SOUTH MADISON STREET
TUPELO MS
38801
US

IV. Provider business mailing address

1040 B SOUTH MADISON STREET
TUPELO MS
38801
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-4364
  • Fax: 662-844-4365
Mailing address:
  • Phone: 662-844-4364
  • Fax: 662-844-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number13618
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number13618
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CLYDE ALEXANDER SHEEHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 662-844-4364