Provider Demographics
NPI:1952787012
Name:REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM
Entity type:Organization
Organization Name:REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-323-9318
Mailing Address - Street 1:302 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2504
Mailing Address - Country:US
Mailing Address - Phone:662-285-6433
Mailing Address - Fax:662-323-9841
Practice Address - Street 1:682 COLLIER RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-9318
Practice Address - Fax:662-323-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2024-08-07
Deactivation Date:2024-07-29
Deactivation Code:
Reactivation Date:2024-08-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS003658575Medicaid