Provider Demographics
NPI:1609268267
Name:VETERANS HEALTH ADMINSTRATION
Entity Type:Organization
Organization Name:VETERANS HEALTH ADMINSTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:DENARD
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, NCC
Authorized Official - Phone:662-907-0040
Mailing Address - Street 1:947 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9528
Mailing Address - Country:US
Mailing Address - Phone:662-907-0040
Mailing Address - Fax:
Practice Address - Street 1:947 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9528
Practice Address - Country:US
Practice Address - Phone:662-907-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1512286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital