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General NPI Number Information
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NPI Number | 1609268267
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Entity Type | Organization
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Legal Business Name | VETERANS HEALTH ADMINSTRATION
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 947 CLUBHOUSE DR
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City | PEARL
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State | MS
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Zip | 39208-9528
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Country | US
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Telephone | 662-907-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 947 CLUBHOUSE DR
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City | PEARL
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State | MS
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Zip | 39208-9528
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Country | US
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Telephone | 662-907-0040
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MR. KENDRICK DENARD BAILEY
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Credential | LPC-S, NCC
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Telephone | 662-907-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 1512
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License Number State | MS
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