Organization
CHANGE OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA LORRAINE RANDLE (CEO)
(662) 207-3645
Entity
Organization
Contact information
Practice address
411 ROOSEVELT ST, INDIANOLA, MS 38751-3141
(662) 635-9972
(662) 452-5066
Mailing address
411 ROOSEVELT ST, INDIANOLA, MS 38751-3141
(662) 635-0794
(662) 452-5066
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/19/2026
Last updated
01/19/2026
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