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General NPI Number Information
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NPI Number | 1801078415
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Entity Type | Organization
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Legal Business Name | NEURO BEHAVIORAL TREATMENT SYSTEMS, LLC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 357 TOWNE CENTER BLVD SUITE 400
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City | RIDGELAND
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State | MS
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Zip | 39157-4870
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Country | US
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Telephone | 601-899-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 357 TOWNE CENTER BLVD SUITE 400
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City | RIDGELAND
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State | MS
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Zip | 39157-4870
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Country | US
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Telephone | 601-899-5900
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KIMBERLY P RAY
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Credential | PHD
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Telephone | 601-899-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | MS
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