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General NPI Number Information
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NPI Number | 1073626511
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Entity Type | Organization
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Legal Business Name | REGION TEN COMMISSION STATE OF MS
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1415 COLLEGE DRIVE
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City | MERIDIAN
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State | MS
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Zip | 39307-5345
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Country | US
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Telephone | 601-483-4821
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Fax | 601-485-8727
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Provider Business Mailing Address
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Address Line | P.O. BOX 2868
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City | MERIDIAN
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State | MS
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Zip | 39302-2801
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Country | US
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Telephone | 601-483-4821
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Fax | 601-485-8727
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RUSSELL ANDREACCHIO
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Credential | MS
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Telephone | 601-483-4821
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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 | R10-1
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License Number State | MS
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