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General NPI Number Information
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NPI Number | 1679903546
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Entity Type | Organization
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Legal Business Name | NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 499 GLOSTER CREEK VLG SUITE A-3
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City | TUPELO
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State | MS
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Zip | 38801-4600
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Country | US
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Telephone | 662-844-1717
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Fax | 662-680-6416
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Provider Business Mailing Address
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Address Line | 2434 S EASON BLVD
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City | TUPELO
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State | MS
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Zip | 38804-6942
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Country | US
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Telephone | 662-640-4595
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Fax | 662-680-6416
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Authorized Official
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Title or Position | CEO
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Name | RITA BERTHAY
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Credential |
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Telephone | 662-640-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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