Organization
REHOBOTH PSYCHIATRIC SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE E GLENN MD (OWNER)
(888) 561-3380
Entity
Organization
Contact information
Practice address
357 TOWNE CENTER PL STE 400, RIDGELAND, MS 39157-4844
(888) 561-3380
(888) 732-6141
Mailing address
PO BX 1276, MADISON, MS 39130
(888) 561-3380
(888) 732-6141
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15747
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05887866
—
MS
Enumeration date
06/27/2007
Last updated
11/29/2022
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