Provider Demographics
NPI:1275071706
Name:PHONEX FAMILY LIFE CENTER
Entity Type:Organization
Organization Name:PHONEX FAMILY LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-443-7489
Mailing Address - Street 1:51 DEWBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8722
Mailing Address - Country:US
Mailing Address - Phone:601-443-7489
Mailing Address - Fax:
Practice Address - Street 1:51 DEWBERRY CIR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-8722
Practice Address - Country:US
Practice Address - Phone:601-443-7489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13763251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management