Genesis Behavioral Health Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

GENESIS BEHAVIORAL HEALTH SERVICES, LLC

Practice address

357 Towne Center PL Ste 200
Ridgeland, MS 39157-4837

Phone

(769) 524-4578

Fax

(769) 524-4630

NPI assigned

Aug 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Monique Moore, PHDNPI 1154636611

Title

Manager

Phone

(769) 524-4578

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Monique Moore, PHD

  • Clinical Psychologist
  • Jackson, MS
  • NPI 1154636611
  NPD Authorized official

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1265043962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1956",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391301956",
            "telephone_number": "769-524-4578",
            "fax_number": "769-524-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 TOWNE CENTER PL STE 200",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574837",
            "telephone_number": "769-524-4578",
            "fax_number": "769-524-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "769-524-4578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Gatewood, FNP
• Courtney Elizabeth Gaughf, NP
• Susan Denice Gautreau
• GC Logistics, LLC
• Thomas Guion Gee, DMD
• Genesis PT and Rehab Services
• Gentex Pharma
• Alma Marie German, PT
• Dana Milling Germany, NP-C
• Thomas Ferris Gerrets Jr., D.M.D.

• Psychologist in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.