1942579826 NPI number — REGION IV MENTAL HEALTH SERVICES

Table of content: SONDRA ANH NGUYEN RPH (NPI 1396039467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942579826 NPI number — REGION IV MENTAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGION IV MENTAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TIMBER HILLS MENTAL HEALTH
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942579826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORINTH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38835-0839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-286-9883
Provider Business Mailing Address Fax Number:
662-286-9836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 N MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38834-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-286-9883
Provider Business Practice Location Address Fax Number:
662-286-9836
Provider Enumeration Date:
12/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SPEARMAN
Authorized Official First Name:
CHARLIE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUITIVE DIRECTOR
Authorized Official Telephone Number:
662-286-9883

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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