Provider Demographics
NPI:1497131866
Name:REGION 8 MENTAL HEALTH
Entity Type:Organization
Organization Name:REGION 8 MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDDS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:601-824-0342
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0088
Mailing Address - Country:US
Mailing Address - Phone:601-824-0342
Mailing Address - Fax:601-824-0349
Practice Address - Street 1:600 MARQUETTE RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3037
Practice Address - Country:US
Practice Address - Phone:601-824-0342
Practice Address - Fax:601-824-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS103TM1800XMedicaid