=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538802913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL HEALTH SERVICES OF MERIDIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2022
-----------------------------------------------------
Last Update Date | 04/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 8TH ST STE B
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39307-6083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-686-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1833 FRANK MCDANIELS RD
-----------------------------------------------------
City | DE KALB
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39328-6622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-686-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | COURTNEY BENNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-686-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------