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General NPI Number Information
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NPI Number | 1275071706
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Entity Type | Organization
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Legal Business Name | PHONEX FAMILY LIFE CENTER
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 51 DEWBERRY CIR
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City | NATCHEZ
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State | MS
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Zip | 39120-8722
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Country | US
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Telephone | 601-443-7489
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Fax |
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Provider Business Mailing Address
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Address Line | 51 DEWBERRY CIR
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City | NATCHEZ
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State | MS
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Zip | 39120-8722
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Country | US
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Telephone | 601-443-7489
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH SPECIALIST
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Name | LATARA JONES
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Credential |
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Telephone | 601-443-7489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 13763
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License Number State | LA
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