|
| |
|
355 Hwy 37 South Raleigh MS 39153-0355 | |
| (601) 782-9461 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 355 Hwy 37 South, Raleigh, 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 |
|---|---|
355 Hwy 37 South Raleigh MS 39153-0355 Ph: (601) 782-9461 | 355 Hwy 37 South Raleigh MS 39153-0355 Ph: (601) 782-9461 |
| NPI Number | 1144586827 |
|---|---|
| Provider Enumeration Date | 04/06/2012 |
| Last Update Date | 04/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144586827 | NPI | - | NPPES |
| 00018210 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |