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205 N Cherry St Magnolia MS 39652-2819 | |
(601) 783-2353 | |
(601) 783-9003 |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 205 N Cherry St, Magnolia, Mississippi |
Authorized Official Name and Position | Timothy Jason Reed (CEO) |
Authorized Official Contact | 3378021336 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4815 Ihles Rd Lake Charles LA 70605-5900 Ph: (337) 802-1336 | 205 N Cherry St Magnolia MS 39652-2819 Ph: (601) 783-2353 |
NPI Number | 1518414416 |
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Provider Enumeration Date | 09/08/2016 |
Last Update Date | 09/08/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518414416 | NPI | - | NPPES |
20043 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
273R00000X | Psychiatric Unit | 16-275 (Mississippi) | Primary |