Provider Demographics
NPI:1366093791
Name:REGION TEN STATE OF MS
Entity type:Organization
Organization Name:REGION TEN STATE OF MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-483-4821
Mailing Address - Street 1:WEEMS CMHC
Mailing Address - Street 2:1415 COLLEGE DRIVE
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307
Mailing Address - Country:US
Mailing Address - Phone:601-483-4821
Mailing Address - Fax:601-485-8727
Practice Address - Street 1:832 HIGHWAY 19 N STE 510
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5876
Practice Address - Country:US
Practice Address - Phone:601-483-4821
Practice Address - Fax:601-485-8727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGION TEN STATE OF MS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health