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General NPI Number Information
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NPI Number | 1801609128
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Entity Type | Organization
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Legal Business Name | JUDD CENTER INC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1801 E MAIN ST
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City | TUPELO
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State | MS
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Zip | 38804-2934
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Country | US
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Telephone | 662-620-7102
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Fax | 662-620-7106
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Provider Business Mailing Address
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Address Line | PO BOX 167
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City | TUPELO
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State | MS
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Zip | 38802-0167
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Country | US
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Telephone | 662-620-7102
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Fax | 662-620-7106
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Authorized Official
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Title or Position | AGENT
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Name | CHAD PARKER
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Credential |
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Telephone | 662-620-7102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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