Provider Demographics
NPI:1992924625
Name:PROHEALTH SOLUTIONS
Entity type:Organization
Organization Name:PROHEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HESSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:601-749-9477
Mailing Address - Street 1:703 W CANAL ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3918
Mailing Address - Country:US
Mailing Address - Phone:601-749-9477
Mailing Address - Fax:601-889-1265
Practice Address - Street 1:703 W CANAL ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3918
Practice Address - Country:US
Practice Address - Phone:601-749-9477
Practice Address - Fax:601-889-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS44-713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05708224Medicaid