Organization
PHOENIX BEHAVIORAL HEALTH CENTER, PLLC
Active
Organization
PHOENIX BEHAVIORAL HEALTH CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN KIM WAGGONER PSYD, ABPP (CEO)
(228) 819-2171
Entity
Organization
Contact information
Practice address
2112 BIENVILLE BLVD STE K, OCEAN SPRINGS, MS 39564-3067
(228) 819-2171
(228) 205-4986
Mailing address
2112 BIENVILLE BLVD STE K, OCEAN SPRINGS, MS 39564-3067
(228) 819-2171
(833) 779-1879
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TH0004X
Health Psychologist
Primary
—
—
Other
Enumeration date
09/24/2019
Last updated
06/10/2024
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