Provider Demographics
NPI:1992004212
Name:MT. OLIVE BAPTIST CHURCH
Entity Type:Organization
Organization Name:MT. OLIVE BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-582-3475
Mailing Address - Street 1:1313 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-582-3475
Mailing Address - Fax:601-582-0149
Practice Address - Street 1:1313 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-582-3475
Practice Address - Fax:601-582-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS205814101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty