Provider Demographics
NPI:1669835310
Name:MDB BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MDB BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:COMPLETE CARE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-951-9863
Mailing Address - Street 1:215 KATHERINE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9588
Mailing Address - Country:US
Mailing Address - Phone:601-665-4162
Mailing Address - Fax:855-830-3484
Practice Address - Street 1:1911 MISSION 66 STE B
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3762
Practice Address - Country:US
Practice Address - Phone:601-665-4162
Practice Address - Fax:855-830-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2084P0800X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS007877558Medicaid
MS001583061Medicaid