Provider Demographics
NPI:1215751300
Name:PSYCAMORE PSYCHIATRIC PROGRAMS, LLC
Entity type:Organization
Organization Name:PSYCAMORE PSYCHIATRIC PROGRAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-939-5993
Mailing Address - Street 1:2540 FLOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-939-5993
Mailing Address - Fax:601-939-5935
Practice Address - Street 1:28 GLENWOOD PLACE
Practice Address - Street 2:STE B
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:601-939-5993
Practice Address - Fax:601-939-5935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCAMORE PSYCHIATRIC PROGRAMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)