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General NPI Number Information
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NPI Number | 1568495588
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Entity Type | Organization
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Legal Business Name | MARSHALL-JACKSON MENTAL HEALTH BD., INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 2409 HOMER CLAYTON DR
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-2207
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Country | US
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Telephone | 256-582-3203
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Fax | 256-582-3216
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Provider Business Mailing Address
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Address Line | 2409 HOMER CLAYTON DR
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-2207
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Country | US
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Telephone | 256-582-3203
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Fax | 256-582-3216
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Authorized Official
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Title or Position | INTERMIN EXECUTIVE DIRECTOR
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Name | MR. MYRON GARGIS
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Credential | LCSW
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Telephone | 256-582-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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