Provider Demographics
NPI:1083980684
Name:REGION TEN COMMISSION ON MENTAL HEALTH
Entity Type:Organization
Organization Name:REGION TEN COMMISSION ON MENTAL HEALTH
Other - Org Name:WEEMS MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-483-4821
Mailing Address - Street 1:1929 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3108
Mailing Address - Country:US
Mailing Address - Phone:601-482-7377
Mailing Address - Fax:
Practice Address - Street 1:1929 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3108
Practice Address - Country:US
Practice Address - Phone:601-482-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEEMS MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018210Medicaid
MS00018210Medicaid