Provider Demographics
NPI:1477448066
Name:PREMIER BEHAVIORAL HEALTH OF JXN, PLLC
Entity type:Organization
Organization Name:PREMIER BEHAVIORAL HEALTH OF JXN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:662-213-5784
Mailing Address - Street 1:5070 SUNNYVALE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4843
Mailing Address - Country:US
Mailing Address - Phone:662-213-5784
Mailing Address - Fax:
Practice Address - Street 1:3304 N STATE ST STE 201A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-3129
Practice Address - Country:US
Practice Address - Phone:662-213-5784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)