NPIMap

Organization Active NPI

Psycamore, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Southaven, MS
National Provider Identifier
1043465040
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PSYCAMORE, LLC
Practice address
7165 Getwell Rd
Building 3, Suite 1 & 2
Southaven, MS 38672-9659
Phone
(800) 779-2448
Fax
(601) 993-5935
NPI assigned
Nov 19, 2008
Last updated
Nov 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

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

Authorized official

Name
Ms. Kimberly Lichte-Madakasira, LPC, LMFTNPI 1356502165
Title
Vice-President
Phone
(601) 939-5993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

7165 Getwell Rd
Building 3, Suite 1 & 2
Southaven, MS 38672-9659

Mailing address

2540 Flowood Dr
Flowood, MS 39232-9362
Phone (601) 939-5993

National Provider Directory

National Provider Directory
Tax ID family
Psycamore LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7165 Getwell Rd
Bldg 3
Southaven, MS 38672
Phone (800) 779-2448

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1043465040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 FLOWOOD DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329362",
            "telephone_number": "601-939-5993",
            "fax_number": "601-939-5935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7165 GETWELL RD",
            "address_2": "BUILDING 3, SUITE 1 & 2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729659",
            "telephone_number": "800-779-2448",
            "fax_number": "601-993-5935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCAMORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "LICHTE-MADAKASIRA",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "601-939-5993",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, LMFT"
    },
    "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": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.