Provider Demographics
NPI:1710447982
Name:YOU MATTER ADOLESCENT WOMEN CLINIC
Entity Type:Organization
Organization Name:YOU MATTER ADOLESCENT WOMEN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-751-8847
Mailing Address - Street 1:3089 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9224
Mailing Address - Country:US
Mailing Address - Phone:601-813-5249
Mailing Address - Fax:
Practice Address - Street 1:3089 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-9224
Practice Address - Country:US
Practice Address - Phone:601-813-5249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center