institution
Region 12 Commission On Mental Health & Retardation Pine Belt Men
Mental Health Clinic/Center (Including Community Mental Health Center) in Hattiesburg, Mississippi
NPI 1982610572

Region 12 Commission On Mental Health & Retardation Pine Belt Men is a Mental Health Clinic/Center (Including Community Mental Health Center) based in Hattiesburg, MS and is specialized in Mental Health (Including Community Mental Health Center). Region 12 Commission On Mental Health & Retardation Pine Belt Men practices in Hattiesburg, MS. The NPI Number for Region 12 Commission On Mental Health & Retardation Pine Belt Men is 1982610572 and holds a License No. R12-1 (Mississippi).

The current practice location address for Region 12 Commission On Mental Health & Retardation Pine Belt Men is 103 S 19Th Ave, Hattiesburg, MS and can be reached out via phone at 601-544-4641 and via fax at 601-584-4053.

Location: 103 S 19Th Ave, Hattiesburg, MS, 39404-8679
institution
Provider Profile Details
NPI Number
1982610572
Provider Name
Region 12 Commission On Mental Health & Retardation Pine Belt Men
Credential
Provider Entity Type
Organization
Address
103 S 19Th Ave, Hattiesburg, MS, 39404-8679
Phone Number
601-544-4641
Fax Number
601-584-4053
Provider Enumeration Date
08/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00018212 05 MS
R121 01 MS DMH CERTIFICATION
institution
Provider Business Practice Location Address Details
Address
103 S 19Th Ave
City
State
Zip
39401-6171
Phone Number
601-544-4641
Fax Number
601-584-4053
person
Provider Business Mailing Address Details
Address
103 S 19Th Ave
City
State
Zip
39401-6171
Phone Number
601-544-4641
Fax Number
601-584-4053
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
License No.
R12-1 (Mississippi)
Definition
Definition to come...
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