=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932995586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USDR BEHAVIORAL SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 962 NORTH ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39202-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-235-8278
-----------------------------------------------------
Fax | 601-368-6572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 CLINTON BLVD STE F
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39056-5254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-235-8278
-----------------------------------------------------
Fax | 601-368-6572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/ OWNER
-----------------------------------------------------
Name | UDARIKA ROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-720-4837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------