| Mississippi State University | |
|
406 22nd Ave Fl 3 Meridian MS 39301-5851 | |
| (601) 484-0207 | |
| Not Available |
| Full Name | Mississippi State University |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 406 22nd Ave Fl 3, Meridian, Mississippi |
| Authorized Official Name and Position | Jeremy Clay (DIRECTOR OF CONTRACT ADMINISTRATION) |
| Authorized Official Contact | 6623258131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippi State University 1000 Highway 19 N Meridian MS 39307-5771 Ph: () - | Mississippi State University 406 22nd Ave Fl 3 Meridian MS 39301-5851 Ph: (601) 484-0207 |
| NPI Number | 1588491823 |
|---|---|
| Provider Enumeration Date | 09/19/2024 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588491823 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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