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General NPI Number Information
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NPI Number | 1477048791
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMMUNITIES BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 402 GREENWOOD ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2626
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Country | US
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Telephone | 601-448-5171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78
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City | PORT GIBSON
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State | MS
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Zip | 39150-0078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN REEVES
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Credential |
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Telephone | 630-379-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2212
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License Number State | MS
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