| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 13682 Hwy 80 West, Forest, Mississippi |
| Authorized Official Name and Position | Maurice Kahlmus (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6014834821 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13682 Hwy 80 West Forest MS 39074 Ph: (601) 469-2211 | 13682 Hwy 80 West Forest MS 39074 Ph: (601) 469-2211 |
| NPI Number | 1154687838 |
|---|---|
| Provider Enumeration Date | 04/06/2012 |
| Last Update Date | 04/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154687838 | NPI | - | NPPES |
| 00018210 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |