Organization
MISSISSIPPI BEHAVIORAL HEALTH TREATMENT INSTITUTE INCORPORATED INC
Active
Other names
Mississippi Behavioral Health Treatment Institute
Organization subpart
No
Provider details
NPI number
Authorized official
KHARI ABAYOMI OMOLARA MD (MEDICAL DIRECTOR)
(601) 996-1758
Entity
Organization
Contact information
Practice address
394 IMPERIAL LN SW, BOGUE CHITTO, MS 39629-8231
(601) 996-1758
(601) 797-8406
Mailing address
PO BOX 3129, BROOKHAVEN, MS 39603-7129
(601) 996-1758
(601) 797-8406
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000126454
—
MS
05
—
009120058
—
MS
05
—
2522183
—
LA
05
—
3663198
—
LA
Enumeration date
09/29/2015
Last updated
03/04/2024
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