Ssipp Select Basketball & Mentoring Program Non Profit

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT

Practice address

3 Nottingham Cir
Gulfport, MS 39503-4021

Phone

(662) 519-1608

NPI assigned

Jun 28, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Leonard C Bennett

Title

Director

Phone

(662) 519-1608

Specialties & licenses 5

Addresses

Other names 2

• SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT Doing business as
• SSiPP Select Basketball & Mentoring Non Profit Doing business as

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1396315792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NOTTINGHAM CIR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034021",
            "telephone_number": "662-519-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 NOTTINGHAM CIR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034021",
            "telephone_number": "662-519-1608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Nottingham Cir",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395034021",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-27",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "662-519-1608",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSiPP Select Basketball & Mentoring Non Profit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Spine Medical Center,LLC
• Marcella Darice Spinnato, R.N.
• Jaden Spradlin
• Mary Elizabeth Sprague, R.N.
• Angela Marie Spring, MSW
• Suzanne Staats-Puffer, CFNP, PMHNP
• Adrian M Stahl, SLP-CCCS
• Lynn Stalnaker, LCSW
• Maya Stampley
• Gregory C Stanford, BCBA, LBA

• Community/Behavioral Health Agency in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Community/Behavioral Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.