| Northeast Mental Health-menta | |
|
2434 S Eason Blvd Tupelo MS 38804-6942 | |
| (662) 640-4695 | |
| (662) 680-6416 |
| Full Name | Northeast Mental Health-menta |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2434 S Eason Blvd, Tupelo, Mississippi |
| Authorized Official Name and Position | Raquel Rosamond (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6626404595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Mental Health-menta 2434 S Eason Blvd Tupelo MS 38804-6942 Ph: (662) 640-4595 | Northeast Mental Health-menta 2434 S Eason Blvd Tupelo MS 38804-6942 Ph: (662) 640-4695 |
| NPI Number | 1801828496 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 10/28/2020 |
| Certification Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801828496 | NPI | - | NPPES |
| 00018203 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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