Provider Demographics
NPI:1194493858
Name:HEALTHY HEART AND MIND BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:HEALTHY HEART AND MIND BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-951-4341
Mailing Address - Street 1:2575 TANK RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-8394
Mailing Address - Country:US
Mailing Address - Phone:601-951-4341
Mailing Address - Fax:
Practice Address - Street 1:506 W MARION AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2720
Practice Address - Country:US
Practice Address - Phone:601-951-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty