Provider Demographics
NPI:1417443862
Name:HORIZON BEHAVIORAL AND SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:HORIZON BEHAVIORAL AND SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:662-571-5632
Mailing Address - Street 1:410 WEBSTER AVE.
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194
Mailing Address - Country:US
Mailing Address - Phone:662-571-5632
Mailing Address - Fax:
Practice Address - Street 1:930 LAMAR AVE.
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-3919
Practice Address - Country:US
Practice Address - Phone:662-571-5632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSHBSS-AGENCYOtherDEPARTMENT OF MENTAL HEALTH