Provider Demographics
NPI:1104296938
Name:FUSION BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:FUSION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ARVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-340-3440
Mailing Address - Street 1:219 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4139
Mailing Address - Country:US
Mailing Address - Phone:601-340-3440
Mailing Address - Fax:
Practice Address - Street 1:219 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4139
Practice Address - Country:US
Practice Address - Phone:601-340-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03932311Medicaid