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7 Jonathan Way Ellisville MS 39437-5195 | |
(817) 473-1312 | |
(866) 990-2813 |
Full Name | |
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Speciality | Clinical Nurse Specialist - Psychiatric/mental Health, Child & Adolescent |
Location | 7 Jonathan Way, Ellisville, Mississippi |
Authorized Official Name and Position | Zemelda D. Carr (ADM) |
Authorized Official Contact | 8174731312 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2001 Se Green Oak Blvd Ste 130 Arlington TX 76018-0952 Ph: (817) 473-1312 | 7 Jonathan Way Ellisville MS 39437-5195 Ph: (817) 473-1312 |
NPI Number | 1023625894 |
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Provider Enumeration Date | 09/25/2020 |
Last Update Date | 07/30/2021 |
Certification Date | 07/30/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023625894 | NPI | - | NPPES |
03320311 | Medicaid | MS | |
25D2200016 | Other | MS | CLIA |
1C5803 | Other | TX | GROUP |
Knox Academy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 W Paulding Rd, Ellisville, MS 39437 Phone: 601-800-4000 |