| Your Family Clinic Llc | |
|
514 Old Richton Rd Petal MS 39465-2920 | |
| (601) 544-8935 | |
| (601) 544-8935 |
| Full Name | Your Family Clinic Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 514 Old Richton Rd, Petal, Mississippi |
| Authorized Official Name and Position | Daniel Tamour Moore (OWNER) |
| Authorized Official Contact | 6015448935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Family Clinic Llc 67 Mars Hill Rd Petal MS 39465-8343 Ph: (601) 544-8935 | Your Family Clinic Llc 514 Old Richton Rd Petal MS 39465-2920 Ph: (601) 544-8935 |
| NPI Number | 1891192068 |
|---|---|
| Provider Enumeration Date | 12/03/2014 |
| Last Update Date | 12/03/2014 |
| Medicare PECOS PAC ID | 7214250158 |
|---|---|
| Medicare Enrollment ID | O20141229000338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891192068 | NPI | - | NPPES |
| 1861400244 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 948493 (Mississippi) | Primary |
| Provider Name | Daniel T Moore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861400244 PECOS PAC ID: 3678896347 Enrollment ID: I20150105000842 |
Cline Consulting Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 302 Mitchell St, Petal, MS 39465 Phone: 601-331-9019 |