Provider Demographics
NPI:1790802908
Name:JULIE ROSS, NP, PLLC DBA BROOKHAVEN NEUROBEHAVIORAL CLINIC
Entity Type:Organization
Organization Name:JULIE ROSS, NP, PLLC DBA BROOKHAVEN NEUROBEHAVIORAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-833-0895
Mailing Address - Street 1:215 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3245
Mailing Address - Country:US
Mailing Address - Phone:601-833-0895
Mailing Address - Fax:601-835-0610
Practice Address - Street 1:215 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3245
Practice Address - Country:US
Practice Address - Phone:601-833-0895
Practice Address - Fax:601-835-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC09691041C0700X
MSR672718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1154477651OtherJULIE ROSS - NPI
MS08178571Medicaid
MSQ46987Medicare UPIN