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General NPI Number Information
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NPI Number | 1225794902
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Entity Type | Organization
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Legal Business Name | MELLOW MINDS BEHAVIORAL HEALTH WELLNESS & COUNSELING CENTER
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 225 COMMUNITY DR
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City | FAYETTE
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State | MS
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Zip | 39069-7701
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Country | US
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Telephone | 601-809-0500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2422
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City | FAYETTE
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State | MS
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Zip | 39069-2422
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Country | US
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Telephone | 601-317-8181
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. ROBIN WILLIAMS-BAILEY
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Credential | DNP
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Telephone | 601-317-8181
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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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