Refined Therapy Group, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REFINED THERAPY GROUP, LLC

Practice address

1403 43Rd Ave Ste D
Gulfport, MS 39501-2545

Phone

(601) 215-5545

NPI assigned

May 30, 2022

Last updated

Jan 21, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Riva Cornelius, LCSWNPI 1881287118

Title

Owner

Phone

(228) 493-9141

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Riva Cornelius, LCSW

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1881287118
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674259200000",
    "number": "1003555079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 W SECOND ST APT 257",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395605513",
            "telephone_number": "228-493-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 43RD AVE STE D",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012545",
            "telephone_number": "601-215-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REFINED THERAPY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-30",
        "last_updated": "2023-01-21",
        "certification_date": "2023-01-21",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "RIVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-493-9141",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Read
• Rebecca Gilliland LCSW PLLC
• Lakisha Redmond, RMA, CCMA, AHI, PBT
• Haylie Reed, MD
• Roger H Reed, M.D.
• Holly Regan
• Reggie H. Broom, D.M.D., P.a.
• Jo Ellen Reid, LCSW
• Sarah Rein
• Amy Remel

• Mental Health Clinic/Center (Including Community Mental Health Center) in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.