MEDICARE: TOP TIER THERAPY & PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265254114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOP TIER THERAPY & PSYCHIATRY

Provider Business Mailing Address
First Line	:	PO BOX 1002
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39060-1002
Country	:	US
Telephone Number	:	601-910-1168
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 REMINGTON CV
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-4559
Country	:	US
Telephone Number	:	601-910-1168
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. QUARTIVIA RO'SCHELL GIBSON
Credential	:	PMHNP-BC
Telephone Number	:	601-910-1168

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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