Provider Demographics
NPI:1669744314
Name:JENNIFER TRIHOULIS MD, LLC
Entity type:Organization
Organization Name:JENNIFER TRIHOULIS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIHOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-336-2220
Mailing Address - Street 1:5266 OLD HIGHWAY 11 STE 70-309
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7817
Mailing Address - Country:US
Mailing Address - Phone:601-336-2220
Mailing Address - Fax:601-336-2221
Practice Address - Street 1:1113 HIGHWAY 98 BYP STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3746
Practice Address - Country:US
Practice Address - Phone:601-336-2220
Practice Address - Fax:601-336-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS196312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty