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General NPI Number Information
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NPI Number | 1922382258
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Entity Type | Organization
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Legal Business Name | SIMPLE STROKES BEHAVIORAL AND MENTAL HEALTH GROUP INC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 83 AIRWAYS PL
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5885
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Country | US
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Telephone | 662-349-8787
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Fax | 662-349-8757
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Provider Business Mailing Address
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Address Line | 83 AIRWAYS PL
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5885
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Country | US
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Telephone | 662-349-8787
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Fax | 662-349-8757
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Authorized Official
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Title or Position | MENTAL HEALTH DEPARTMENT MANAGER
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Name | DR. SHEILA WILLIAMSON
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Credential | PH.D
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Telephone | 662-349-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 35-594
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License Number State | MS
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