| Community Mental Health Clinic, Llc | |
|
200 Saint Paul St Pearl MS 39208-5134 | |
| (601) 665-7983 | |
| Not Available |
| Full Name | Community Mental Health Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Saint Paul St, Pearl, Mississippi |
| Authorized Official Name and Position | Latonya Jaton Mcgowan (OWNER) |
| Authorized Official Contact | 6016657983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Mental Health Clinic, Llc 1393 Old Pearson Rd Florence MS 39073-9468 Ph: (601) 665-7983 | Community Mental Health Clinic, Llc 200 Saint Paul St Pearl MS 39208-5134 Ph: (601) 665-7983 |
| NPI Number | 1871358184 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 6406398544 |
|---|---|
| Medicare Enrollment ID | O20240605000441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871358184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Latonya Jaton Mcgowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467018390 PECOS PAC ID: 7719219419 Enrollment ID: I20191030001144 |
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