Provider Demographics
NPI:1154676310
Name:MENTAL HEALTH ASSOCIATION OF SOUTH MISSISSIPPI
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF SOUTH MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DANEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-864-6274
Mailing Address - Street 1:4803 HARRISON CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-4402
Mailing Address - Country:US
Mailing Address - Phone:228-864-6274
Mailing Address - Fax:228-864-1310
Practice Address - Street 1:4803 HARRISON CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-4402
Practice Address - Country:US
Practice Address - Phone:228-864-6274
Practice Address - Fax:228-864-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable