| Safe Harbor Clinic Llc | |
|
4013 Beatline Rd Ste A Long Beach MS 39560 | |
| (228) 200-0720 | |
| (228) 200-0383 |
| Full Name | Safe Harbor Clinic Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4013 Beatline Rd Ste A, Long Beach, Mississippi |
| Authorized Official Name and Position | Dustin Marmalich (OWNER) |
| Authorized Official Contact | 2282000720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Harbor Clinic Llc 4013 Beatline Rd Ste A Long Beach MS 39560-4135 Ph: (228) 200-0720 | Safe Harbor Clinic Llc 4013 Beatline Rd Ste A Long Beach MS 39560 Ph: (228) 200-0720 |
| NPI Number | 1609352384 |
|---|---|
| Provider Enumeration Date | 07/16/2018 |
| Last Update Date | 08/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609352384 | NPI | - | NPPES |
| 04334707 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C9311 (Mississippi) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 25543 (Mississippi) | Primary |
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