Provider Demographics
NPI:1194607416
Name:THEIA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:THEIA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-277-2656
Mailing Address - Street 1:355 DECELLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-3140
Mailing Address - Country:US
Mailing Address - Phone:601-454-0395
Mailing Address - Fax:
Practice Address - Street 1:317 E CAPITOL ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-3405
Practice Address - Country:US
Practice Address - Phone:601-277-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty