Provider Demographics
NPI:1154433233
Name:REGION VI COMMUNITY MENTAL HEALTH COMMISSION
Entity type:Organization
Organization Name:REGION VI COMMUNITY MENTAL HEALTH COMMISSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHAEDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-453-6211
Mailing Address - Street 1:PO BOX 1505
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1505
Mailing Address - Country:US
Mailing Address - Phone:662-453-6211
Mailing Address - Fax:662-455-8724
Practice Address - Street 1:2504 BROWNING ROAD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-453-6211
Practice Address - Fax:662-455-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770318Medicaid
MS00770409Medicaid
MS09581272Medicaid
MS01253876Medicaid
MS00018206Medicaid