Provider Demographics
NPI:1396196879
Name:MISSISSIPPI BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MISSISSIPPI BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:QUENTIN
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:318-675-0804
Mailing Address - Street 1:860 E RIVER PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 E RIVER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3442
Practice Address - Country:US
Practice Address - Phone:769-251-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCM HOLDING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health