Northeast Mental Health/Mental Retardation Commission
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Tupelo, MS
NPI 1801828496 · NPPES record last updated Oct 28, 2020
Key facts
- NPI
- 1801828496
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- NORTHEAST MENTAL HEALTH/MENTAL RETARDATION COMMISSION
- Practice address
- 2434 S Eason Blvd
Tupelo, MS 38804-6942 - Phone
- (662) 640-4695
- Fax
- (662) 680-6416
- NPI assigned
- Jul 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Raquel Rosamond
- Title
- Executive Director
- Phone
- (662) 640-4595
Other NPIs on the same Medicare enrollment 2
Member organizations 2
Practitioners 15
-
Ross E Collins Jr., M.D.
-
Susan Duffie, CFNP
-
Katherine E Ederer, PMHNP
-
Lisa D Foley, CFNP
-
Lea Ann Hillhouse, LPC
-
Lisa Tyer Kwasinski, LCSW
-
Aretha M. Northington, PMHNP
-
Melissa Ratliff, M.ED.
-
Janet Richey, CFNP
-
Michael Dean Roberts, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040223000473 | MS | Part B Supplier - Clinic/Group Practice | 5193611747 |
Receives reassigned benefits from 17 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tupelo, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
2434 S Eason Blvd
Tupelo, MS 38804-6942
Mailing address
2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone (662) 640-4595
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018203 | Medicaid | MS |
Other names
- Northeast Mental Health-Menta
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amerchant@lifecorehealthgroup.com |
Other providers in Tupelo, MS
- North Ms Emergency Physicians
- Northeast Community Services
- Northeast Mental Health-Mental Retardation Commission
- Northeast Mental Health-Mental Retardation Commission
- Northeast Mental Health-Mental Retardation Commission
- Allison Burks Norwood
- Jessica Ruth Nunley
- Nurse Anesthesia Providers, Inc
- Sarah O'Brien
- Amy O'Daniel
All providers in Tupelo, MS · Mental Health Clinic/Center (Including Community Mental Health Center) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.