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General NPI Number Information
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NPI Number | 1003469743
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Entity Type | Organization
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Legal Business Name | URBAN REHAB, INC
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 901 HIGHWAY 80 E
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City | CLINTON
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State | MS
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Zip | 39056-5244
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Country | US
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Telephone | 601-927-0188
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Fax | 601-292-7998
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Provider Business Mailing Address
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Address Line | PO BOX 2305
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City | CLINTON
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State | MS
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Zip | 39060-2305
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Country | US
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Telephone | 601-927-0188
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Fax | 601-292-7998
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PHILIP MASSEY
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Credential | LCSW, CADC II
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Telephone | 601-927-0188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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