NPI 1306178694

Region 8 Mh/Mr Commission

Organisation Intellectual & Developmental Disabilities Psychologist Brandon, MS

Practice location

Address: 613 Marquette Road, Brandon, MS 39042
Phone: (601) 824-0342
Fax: (601) 824-0349
Mailing address: PO Box 88 613 Marquette Road, Brandon, MS 39042

Authorised official

Name: Dave van
Title: Executive Director
Phone: (601) 824-0342

Registered specialties

Intellectual & Developmental Disabilities Psychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103TM1800X Licence R08-BMR-WAC-PREVOC-0 (MS)

Other Psychologist providers in Mississippi →

Registry record

NPI: 1306178694
Entity type: Organization
NPI issued: 11 Feb 2010
Record last updated: 27 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.