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General NPI Number Information
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NPI Number | 1154676310
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH ASSOCIATION OF SOUTH MISSISSIPPI
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 4803 HARRISON CIR
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City | GULFPORT
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State | MS
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Zip | 39507-4402
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Country | US
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Telephone | 228-864-6274
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Fax | 228-864-1310
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Provider Business Mailing Address
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Address Line | 4803 HARRISON CIR
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City | GULFPORT
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State | MS
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Zip | 39507-4402
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Country | US
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Telephone | 228-864-6274
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Fax | 228-864-1310
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KAY MARIE DANEAULT
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Credential |
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Telephone | 228-864-6274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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