Provider Demographics
NPI:1457006090
Name:RIMMER, TOMMIE LEE
Entity Type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:LEE
Last Name:RIMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S FRONTAGE RD LOT 63
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6255
Mailing Address - Country:US
Mailing Address - Phone:601-201-3858
Mailing Address - Fax:
Practice Address - Street 1:1401 S FRONTAGE RD LOT 63
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-6255
Practice Address - Country:US
Practice Address - Phone:601-201-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS326704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health