Provider Demographics
NPI:1386272094
Name:MISSISSIPPI BEHAVIORAL HEALTH CARE, LLC
Entity type:Organization
Organization Name:MISSISSIPPI BEHAVIORAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:225-239-5498
Mailing Address - Street 1:8786 GOODWOOD BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7917
Mailing Address - Country:US
Mailing Address - Phone:225-239-5498
Mailing Address - Fax:225-239-5543
Practice Address - Street 1:299 APACHE DR STE C
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-6301
Practice Address - Country:US
Practice Address - Phone:225-239-5498
Practice Address - Fax:225-239-5543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISS LOU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-29
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health