Organization
MIDSOUTH BEHAVIORAL HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERRY NICHOLS (ACCTS. MANAGER)
(662) 895-1707
Entity
Organization
Contact information
Practice address
6810 CRUMPLER BLVD, SUITE 302, OLIVE BRANCH, MS 38654-1933
(662) 895-1707
(662) 893-0388
Mailing address
PO BOX 579, OLIVE BRANCH, MS 38654-0579
(662) 895-1707
(662) 893-0388
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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