Provider Demographics
NPI:1982769675
Name:SASSAFRAS HILL COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:SASSAFRAS HILL COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA
Authorized Official - Phone:601-264-9515
Mailing Address - Street 1:4824 OLD HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3567
Mailing Address - Country:US
Mailing Address - Phone:601-264-9515
Mailing Address - Fax:601-271-7026
Practice Address - Street 1:4824 OLD HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-3567
Practice Address - Country:US
Practice Address - Phone:601-264-9515
Practice Address - Fax:601-271-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-24
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)