| Journeypure Mississippi Medical Group Llc | |
|
8829 Centre St Southaven MS 38671-2610 | |
| (662) 536-6542 | |
| (662) 314-9689 |
| Full Name | Journeypure Mississippi Medical Group Llc |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 8829 Centre St, Southaven, Mississippi |
| Authorized Official Name and Position | Kim Cooper (HUMAN RESOURCES) |
| Authorized Official Contact | 6625366542 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Journeypure Mississippi Medical Group Llc 8829 Centre St Ste 200 Southaven MS 38671-2610 Ph: (662) 536-6542 | Journeypure Mississippi Medical Group Llc 8829 Centre St Southaven MS 38671-2610 Ph: (662) 536-6542 |
| NPI Number | 1780127845 |
|---|---|
| Provider Enumeration Date | 11/22/2016 |
| Last Update Date | 06/16/2020 |
| Certification Date | 06/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780127845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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