Organization
MIND REPOSE LLC
Active
Other names
Blue Rose Detox Mansion, Mind Repose LLC, The Historic Blue Rose Recovery Mansion
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL CASE SR. PHD (CEO)
(480) 300-2655
Entity
Organization
Contact information
Practice address
120 W SCENIC DR, PASS CHRISTIAN, MS 39571-4420
(480) 300-2655
Mailing address
800 3RD AVE STE 1143, NEW YORK, NY 10022-7649
(480) 300-2655
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
102L00000X
Psychoanalyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134710817
STATE OF MISSISSIPPI
MS
Enumeration date
01/25/2022
Last updated
01/25/2022
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