Provider Demographics
NPI:1417213323
Name:REGION TEN COMMISION ON MENTAL HEALTH
Entity Type:Organization
Organization Name:REGION TEN COMMISION ON MENTAL HEALTH
Other - Org Name:WEEMS MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-483-4821
Mailing Address - Street 1:1011 POSEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350
Mailing Address - Country:US
Mailing Address - Phone:601-656-3451
Mailing Address - Fax:
Practice Address - Street 1:1011 POSEY AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350
Practice Address - Country:US
Practice Address - Phone:601-656-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGION TEN COMMISION ON MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018210Medicaid
MS00018210Medicaid