Provider Demographics
NPI:1083160782
Name:CHANDRA SUMLIN-BROWN DBA SUMLIN BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:CHANDRA SUMLIN-BROWN DBA SUMLIN BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:SUMLIN-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:601-480-6232
Mailing Address - Street 1:8237B OKATIBBEE DAM ROAD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325
Mailing Address - Country:US
Mailing Address - Phone:601-480-6232
Mailing Address - Fax:
Practice Address - Street 1:8237B OKATIBBEE DAM ROAD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39325
Practice Address - Country:US
Practice Address - Phone:601-480-6232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR886070283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09532822Medicaid
MS425235054AOtherBLUE CROSS BLUE SHIELD
MS09532822Medicaid