Safe Harbor Clinic LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25543 Issued in MS

Legal business name

SAFE HARBOR CLINIC LLC

Practice address

4013 Beatline Rd Ste a
Long Beach, MS 39560

Phone

(228) 200-0720

Fax

(228) 200-0383

NPI assigned

Jul 16, 2018

Organization subpart

No

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

Authorized official

Name

Dustin Marmalich, MD

Title

Owner

Phone

(228) 200-0720

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1531699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1609352384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 BEATLINE RD STE A",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604135",
            "telephone_number": "228-200-0720",
            "fax_number": "228-200-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 BEATLINE RD STE A",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "39560",
            "telephone_number": "228-200-0720",
            "fax_number": "228-200-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-16",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "MARMALICH",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-200-0720",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C9311",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "25543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04334707",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Relationship Couch, LLC
• Relief LLC (The Relief Clinic)
• Megan Kristine Runkel, LMP
• Geraldine Runyon
• Kurt Michael Russell
• Safe Harbor Clinic LLC
• Arvetta Marie Sands
• Bruce Saylor, M.D.
• Richard C. Schaefer, RPH
• Sarah Anne Schroeder, PT

• Psychiatry Physician in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; 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.