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General NPI Number Information
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NPI Number | 1952047391
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Entity Type | Organization
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Legal Business Name | WEST MISSISSIPPI BEHAVIORAL SERVICE, LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 3201 WISCONSIN AVE
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City | VICKSBURG
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State | MS
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Zip | 39180-5350
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Country | US
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Telephone | 601-636-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 WISCONSIN AVE
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City | VICKSBURG
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State | MS
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Zip | 39180-5350
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Country | US
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Telephone | 601-636-8006
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Fax |
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Authorized Official
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Title or Position | OWNER / LLC MEMBER
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Name | DR. DANIEL P EDNEY
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Credential | MD
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Telephone | 601-831-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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