Provider Demographics
NPI:1487984407
Name:REGION IV MENTAL HEALTH
Entity type:Organization
Organization Name:REGION IV MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUITIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:662-720-4816
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-720-4816
Mailing Address - Fax:662-720-4832
Practice Address - Street 1:2301C EAST CHAMBERS DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-8903
Practice Address - Country:US
Practice Address - Phone:662-720-4816
Practice Address - Fax:662-720-4832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGION IV MENTAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-14
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)