Provider Demographics
NPI:1801078415
Name:NEURO BEHAVIORAL TREATMENT SYSTEMS, LLC
Entity type:Organization
Organization Name:NEURO BEHAVIORAL TREATMENT SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-899-5900
Mailing Address - Street 1:357 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4870
Mailing Address - Country:US
Mailing Address - Phone:601-899-5900
Mailing Address - Fax:
Practice Address - Street 1:357 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4870
Practice Address - Country:US
Practice Address - Phone:601-899-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS36618OtherPSYCHOLOGIST
MS00119527Medicaid