Provider Demographics
NPI:1487864476
Name:BROOKHAVEN PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:BROOKHAVEN PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:601-833-8413
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39602-0183
Mailing Address - Country:US
Mailing Address - Phone:601-833-8413
Mailing Address - Fax:601-833-8802
Practice Address - Street 1:1001 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2465
Practice Address - Country:US
Practice Address - Phone:601-833-8413
Practice Address - Fax:601-833-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty