REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE BELT MEN NPI 1982610572

NPI Information

NPI: 1982610572
Provider Name: REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE BELT MEN

Doing Business As: PINE BELT MENTAL HEALTH CARE RESOURCES

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
103 S 19TH AVE
HATTIESBURG, MS
ZIP 39401
Phone: (601) 544-4641
Get Directions

REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE BELT MEN is a mental health (including community mental health center) clinic center in Hattiesburg, MS. REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE BELT MEN NPI is 1982610572. The provider is registered as an organization entity type.
The provider Is Doing Business As Pine Belt Mental Health Care Resources.

The provider's business location address is:

103 S 19TH AVE
HATTIESBURG, MS
ZIP 39401-171
Phone: (601) 544-4641
Fax: (601) 584-4053

The provider's authorized official is Janet Mays .
The authorized official title is Chief Financial Officer and has the following contact phone number (601) 705-1902.

The CLIA number assigned to this NPI record is 25D1083874 - health fair with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/1/2006 and was last updated on 9/16/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	R12-1	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C00097	MEDICARE ID-TYPE UNSPECIFIED	MISSISSIPPI
2	00018212	MEDICAID	MISSISSIPPI
3	R121	OTHER	MISSISSIPPI	DMH CERTIFICATION

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »