| Region 8 Mh/mr Commission | |
|
613 Marquette Road Brandon MS 39042 | |
| (601) 824-0342 | |
| (601) 824-0349 |
| Full Name | Region 8 Mh/mr Commission |
|---|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
| Location | 613 Marquette Road, Brandon, Mississippi |
| Authorized Official Name and Position | Dave Van (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6018240342 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Region 8 Mh/mr Commission Po Box 88 613 Marquette Road Brandon MS 39042 Ph: (601) 824-0342 | Region 8 Mh/mr Commission 613 Marquette Road Brandon MS 39042 Ph: (601) 824-0342 |
| NPI Number | 1306178694 |
|---|---|
| Provider Enumeration Date | 02/11/2010 |
| Last Update Date | 06/27/2022 |
| Certification Date | 06/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306178694 | NPI | - | NPPES |
| 007700402 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | R08-BMR-WAC-PREVOC-0 (Mississippi) | Primary |
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