Reconnect Wellness Iuka, LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

RECONNECT WELLNESS IUKA, LLC

Practice address

1670 Whitehouse Rd
Iuka, MS 38852-9013

Phone

(662) 680-3148

Fax

(662) 620-9890

NPI assigned

May 18, 2017

Organization subpart

No

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

Authorized official

Name

Douglas M Wright

Title

Managing Member Reconnect Outpatien

Phone

(662) 680-3148

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495065600000",
    "number": "1225565450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3667",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033667",
            "telephone_number": "662-680-3148",
            "fax_number": "662-620-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 WHITEHOUSE RD",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388529013",
            "telephone_number": "662-680-3148",
            "fax_number": "662-620-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECONNECT WELLNESS IUKA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-18",
        "last_updated": "2017-05-18",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING MEMBER RECONNECT OUTPATIEN",
        "authorized_official_telephone_number": "662-680-3148"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Michael Pryce-Jones
• Kathy Putman, LPC
• Mary Elizabeth Raiford
• Haley Raper
• Reconnect Therapy
• Region IV Mental Health Services
• Region IV Mental Health Services Beacon House
• Megean Elaine Remedios, FNP-C
• Pamela Renee Richardson, BSW
• Regina Riddle, MS

• Preferred Provider Organization in Iuka, MS
• Providers in Iuka, MS by specialty
• Preferred Provider Organization in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2017; 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.