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Organization

REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE BELT MEN

Active
Other names
Pine Belt Mental Health Care Resources
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JANET MAYS (CHIEF FINANCIAL OFFICER)
(601) 705-1902
Entity
Organization

Contact information

Practice address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
(601) 544-4641
(601) 584-4053
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1906
(601) 705-1952

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
R12-1
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00018212
MS
01
R121
DMH CERTIFICATION
MS
Enumeration date
08/01/2006
Last updated
09/16/2015
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