Provider Demographics
NPI:1225794902
Name:MELLOW MINDS BEHAVIORAL HEALTH WELLNESS & COUNSELING CENTER
Entity Type:Organization
Organization Name:MELLOW MINDS BEHAVIORAL HEALTH WELLNESS & COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:601-317-8181
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-2422
Mailing Address - Country:US
Mailing Address - Phone:601-317-8181
Mailing Address - Fax:
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-7701
Practice Address - Country:US
Practice Address - Phone:601-809-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)