Organization
URBAN REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP MASSEY LCSW, CADC II (EXECUTIVE DIRECTOR)
(601) 927-0188
Entity
Organization
Contact information
Practice address
901 HIGHWAY 80 E, CLINTON, MS 39056-5244
(601) 927-0188
(601) 292-7998
Mailing address
PO BOX 2305, CLINTON, MS 39060-2305
(601) 927-0188
(601) 292-7998
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02551264
—
MS
01
—
URI-AGENCY
DEPARTMENT OF MENTAL HEALTH
MS
Enumeration date
07/22/2019
Last updated
08/03/2020
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