NPIMap

Organization Active NPI

Mississippi Center for Autism and Related Developmental Disabilities

  • Psychologist
  • D'Iberville, MS
National Provider Identifier
1891084414
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MISSISSIPPI CENTER FOR AUTISM AND RELATED DEVELOPMENTAL DISABILITIES
Practice address
4061 Suzanne Dr
Suite C
Diberville, MS 39540-3735
Phone
(228) 396-4434
NPI assigned
Apr 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Aimee M Tisdale, PHD
Title
Program Director
Phone
(228) 806-9936

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X
School PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TS0200X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

4061 Suzanne Dr
Suite C
Diberville, MS 39540-3735

Mailing address

4061 Suzanne Dr
Suite C
Diberville, MS 39540-3735
Phone (228) 396-4434

National Provider Directory

National Provider Directory

Locations

4061 Suzanne Dr
#C
Diberville, MS 39540
Phone (228) 396-4434

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1891084414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 SUZANNE DR",
            "address_2": "SUITE C",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395403735",
            "telephone_number": "228-396-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 SUZANNE DR",
            "address_2": "SUITE C",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395403735",
            "telephone_number": "228-396-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CENTER FOR AUTISM AND RELATED DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "TISDALE",
        "authorized_official_first_name": "AIMEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "228-806-9936",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in D'Iberville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.