Provider Demographics
NPI:1700894730
Name:REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM
Entity Type:Organization
Organization Name:REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM
Other - Org Name:COMMUNITY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-295-6433
Mailing Address - Street 1:1032 STATE HWY 50 W
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773
Mailing Address - Country:US
Mailing Address - Phone:662-524-4347
Mailing Address - Fax:662-524-4370
Practice Address - Street 1:222 MARY HOLMES DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-4400
Practice Address - Country:US
Practice Address - Phone:662-295-6433
Practice Address - Fax:662-323-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR07BR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018207Medicaid
MSC00104Medicare PIN