Providence Behavioral Health Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVIDENCE BEHAVIORAL HEALTH SERVICES

Practice address

5266 Old Highway 11 Ste 50
Hattiesburg, MS 39402-7818

Phone

(678) 834-7615

NPI assigned

Aug 8, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Nikki Kwona Wright, MS

Title

Director

Phone

(678) 834-7615

Specialties & licenses 1

Addresses

Other names 1

• Blackstone Other name

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470614400000",
    "number": "1801340799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5737 OLD NATIONAL HWY STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303493865",
            "telephone_number": "678-834-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5266 OLD HIGHWAY 11 STE 50",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394027818",
            "telephone_number": "678-834-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-08-08",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_middle_name": "KWONA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "678-834-7615",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackstone",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• William S Prosser, DPT
• Proteus Genomics, LLC
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• PRX LLC
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• Devon Pryne
• PSCH, LLC

• Community/Behavioral Health Agency in Hattiesburg, MS
• Providers in Hattiesburg, 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 Aug 8, 2016; 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.