PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES PA NPI 1679135982

NPI Information

PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA is a mental health counselor in Jackson, MS. PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA NPI is 1679135982. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

717 E FORTIFICATION ST
JACKSON, MS
ZIP 39202-402
Phone: (769) 572-4009
Fax: (769) 572-4021

The provider's authorized official is Shameca Leonora Hudson .
The authorized official title is Ceo and has the following contact phone number (769) 572-4009.

The CLIA number assigned to this NPI record is 25D2168476 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/8/2019 and was last updated on 10/28/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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