Provider Demographics
NPI:1225807555
Name:MS COUNSELING AND PSYCHIATRIC CENTER LLC
Entity Type:Organization
Organization Name:MS COUNSELING AND PSYCHIATRIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-322-6259
Mailing Address - Street 1:1893 CLIFF GOOKIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6558
Mailing Address - Country:US
Mailing Address - Phone:662-346-4584
Mailing Address - Fax:662-346-4589
Practice Address - Street 1:1893 CLIFF GOOKIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6558
Practice Address - Country:US
Practice Address - Phone:662-346-4584
Practice Address - Fax:662-346-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health