Provider Demographics
NPI:1508439910
Name:SOUTHLAND RECOVERY, PLLC
Entity Type:Organization
Organization Name:SOUTHLAND RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR & PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:662-510-2523
Mailing Address - Street 1:8830 CENTRE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2609
Mailing Address - Country:US
Mailing Address - Phone:662-510-2523
Mailing Address - Fax:662-510-2527
Practice Address - Street 1:8830 CENTRE ST STE 5
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2609
Practice Address - Country:US
Practice Address - Phone:662-510-2523
Practice Address - Fax:662-510-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty