Provider Demographics
NPI:1609562586
Name:ELY PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:ELY PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY CAY
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:601-646-7800
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-0520
Mailing Address - Country:US
Mailing Address - Phone:601-646-7700
Mailing Address - Fax:888-735-7202
Practice Address - Street 1:213 N PEARMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2633
Practice Address - Country:US
Practice Address - Phone:662-390-6244
Practice Address - Fax:949-561-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty