Organization
SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALYN DATZ PHD (CLINICAL DIRECTOR/OWNER)
(601) 255-1618
Entity
Organization
Contact information
Practice address
1 COMMERCE DR, STE 106, HATTIESBURG, MS 39402-1499
(601) 255-1618
(601) 255-1619
Mailing address
PO BOX 18799, HATTIESBURG, MS 39404-8799
(601) 255-1618
(601) 255-1619
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TH0004X
Health Psychologist
Primary
—
—
Other
Enumeration date
02/07/2011
Last updated
01/15/2013
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