Provider Demographics
NPI:1700103876
Name:MIDSOUTH MENTAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MIDSOUTH MENTAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:901-319-4942
Mailing Address - Street 1:PO BOX 30727
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38130-0727
Mailing Address - Country:US
Mailing Address - Phone:901-319-4942
Mailing Address - Fax:901-729-2412
Practice Address - Street 1:530 OAK COURT DR
Practice Address - Street 2:SUITE 127
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-3726
Practice Address - Country:US
Practice Address - Phone:901-319-4942
Practice Address - Fax:901-729-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN385022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516640Medicaid