Rehoboth Psychiatric Services, PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

15747 Issued in MS

Legal business name

REHOBOTH PSYCHIATRIC SERVICES, PLLC

Practice address

357 Towne Center PL Ste 400
Ridgeland, MS 39157-4844

Phone

(888) 561-3380

Fax

(888) 732-6141

NPI assigned

Jun 27, 2007

Last updated

Nov 29, 2022By 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

Clyde E Glenn, MDNPI 1982612164

Title

Owner

Phone

(888) 561-3380

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Clyde E Glenn, M.D.

  • Psychiatry Physician
  • Ridgeland, MS
  • NPI 1982612164
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1528265246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BX 1276",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39130",
            "telephone_number": "888-561-3380",
            "fax_number": "888-732-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 TOWNE CENTER PL STE 400",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574844",
            "telephone_number": "888-561-3380",
            "fax_number": "888-732-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHOBOTH PSYCHIATRIC SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-561-3380",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "15747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05887866",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.