Organization
REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE
Active
Other names
Pine Belt Mental Healthcare Resources
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY MAYO (CEO)
(601) 544-4641
Entity
Organization
Contact information
Practice address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
(601) 544-4641
(601) 450-4632
Mailing address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
(601) 544-4641
(601) 450-4632
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
07864/5.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117558
PK
—
Enumeration date
10/24/2008
Last updated
02/16/2017
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