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General NPI Number Information
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NPI Number | 1023432135
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Entity Type | Organization
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Legal Business Name | TRINITY BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 1618 PEAR ORCHARD PL
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City | JACKSON
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State | MS
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Zip | 39211-2206
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Country | US
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Telephone | 601-942-1129
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 PEAR ORCHARD PL
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City | JACKSON
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State | MS
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Zip | 39211-2206
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Country | US
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Telephone | 601-942-1129
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. PHYLANDRIA HUDSON
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Credential | LCSW
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Telephone | 601-942-1129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-5832
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License Number State | MS
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