Organization
REBECCA BLOUNT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA G. BLOUNT PMHNP (OWNER)
(601) 569-1567
Entity
Organization
Contact information
Practice address
520A W CANAL ST, PICAYUNE, MS 39466-3915
(601) 599-9500
Mailing address
520A W CANAL ST, PICAYUNE, MS 39466-3915
(769) 926-2511
(769) 926-2509
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
856788
MS BOARD OF NURSING
MS
Enumeration date
05/09/2018
Last updated
11/16/2018
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