MEDICARE: MISSISSIPPI BEHAVIORAL HEALTH SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1396196879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	860 E RIVER PL
Second Line	:	SUITE 100
City	:	JACKSON
State	:	MS
Zip	:	39202-3442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 E RIVER PL
Second Line	:	SUITE 100
City	:	JACKSON
State	:	MS
Zip	:	39202-3442
Country	:	US
Telephone Number	:	769-251-5550
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER QUENTIN MUDD
Credential	:	MPA
Telephone Number	:	318-675-0804

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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