Organization
JOURNEYPURE MISSISSIPPI MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM COOPER (HUMAN RESOURCES)
(662) 536-6542
Entity
Organization
Contact information
Practice address
8829 CENTRE ST, SOUTHAVEN, MS 38671-2610
(662) 536-6542
(662) 314-9689
Mailing address
8829 CENTRE ST STE 200, SOUTHAVEN, MS 38671-2610
(662) 536-6542
(662) 314-9689
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
11/22/2016
Last updated
06/16/2020
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