MEDICARE: JENNIFER TRIHOULIS MD, 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	2084P0800X	Psychiatry Physician	19631	MS

General Provider Information

NPI Number	:	1669744314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER TRIHOULIS MD, LLC

Provider Business Mailing Address
First Line	:	5266 OLD HIGHWAY 11 STE 70-309
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-7817
Country	:	US
Telephone Number	:	601-336-2220
Fax Number	:	601-336-2221

Provider Business Practice Location Address
First Line	:	1113 HIGHWAY 98 BYP STE B
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3746
Country	:	US
Telephone Number	:	601-336-2220
Fax Number	:	601-336-2221

Authorized Official
Title or Position	:	MEMBER
Name	:	JENNIFER TRIHOULIS
Credential	:	MD
Telephone Number	:	601-336-2220

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	01/26/2012

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