Provider Demographics
NPI:1376094532
Name:JACKSON FAMILY FIRST
Entity Type:Organization
Organization Name:JACKSON FAMILY FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-503-4563
Mailing Address - Street 1:125 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2208
Mailing Address - Country:US
Mailing Address - Phone:601-503-4563
Mailing Address - Fax:
Practice Address - Street 1:125 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2208
Practice Address - Country:US
Practice Address - Phone:601-503-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty