Healthcare Provider Details

I. General information

NPI: 1831468248
Provider Name (Legal Business Name): REGION IV MENTAL HEALTH SERVICES--TUPELO CRISIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927A BRIAR RIDGE RD
TUPELO MS
38804-5963
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-680-6250
  • Fax: 662-680-4350
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLIE D SPEARMAN SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-286-9883