Beacon Behavioral of Mississippi, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BEACON BEHAVIORAL OF MISSISSIPPI, LLC

Doing business as

Right Track Medical Group

Practice address

9035 E Sandidge Rd Ste 201
Olive Branch, MS 38654-3563

Phone

(662) 408-4631

NPI assigned

Jul 11, 2024

Last updated

Jul 11, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

BEACON BEHAVIORAL OF MISSISSIPPI, LLCAs reported in NPPES

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

Authorized official

Name

Kimberly Glaveskas

Title

Credentialing Supervisor

Phone

(443) 962-3945

Specialties & licenses 1

Addresses

Other names 1

• Right Track Medical Group Doing business as

Tax ID family

Precise Clinical Neuroscience Specialists3 organizations share this tax ID, including this one

Part of

Precise Clinical Neuroscience Specialists

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Beacon Behavioral of Mississippi, LLC

  dba Precise Clinical Neuroscience Specialists

  • Psychiatry Physician
  • Flowood, MS
  • NPI 1134962525
  NPD tax ID
• Precise Clinical Neuroscience Specialists

  dba Right Track Medical Group

  • Psychiatry Physician
  • Flowood, MS
  • NPI 1770717449
  NPD tax ID

Locations

Practitioners 2

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.

• Stephanie L Hogan, PMNNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Louin, MS
  • NPI 1982375218
  NPD (past)
• Lindsey Jo Rogers, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Starkville, MS
  • NPI 1093390866
  NPD (past)

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1891532305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306603",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306603",
            "telephone_number": "662-234-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9035 E SANDIDGE RD STE 201",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543563",
            "telephone_number": "662-408-4631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4428 S Eason Blvd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388016506",
            "country_code": "US",
            "telephone_number": "662-260-4533",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Aldersgate Cir",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394021301",
            "country_code": "US",
            "telephone_number": "601-909-4080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1641 Popps Ferry Rd Ste A3",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395322226",
            "country_code": "US",
            "telephone_number": "228-232-0890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Highway 12 E",
            "address_purpose": "LOCATION",
            "city": "Starkville",
            "state": "MS",
            "postal_code": "397593766",
            "country_code": "US",
            "telephone_number": "662-498-1900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 Fountains Blvd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106317",
            "country_code": "US",
            "telephone_number": "601-499-1105",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1203 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "MS",
            "postal_code": "386555327",
            "country_code": "US",
            "telephone_number": "662-234-7601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON BEHAVIORAL OF MISSISSIPPI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACON BEHAVIORAL OF MISSISSIPPI, LLC",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "GLAVESKAS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "443-962-3945"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Right Track Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wendy Michelle Ballenger, DO
• Stephanie Barclay, DPT
• Shawanda Barnes, SLP
• Michael David Barnette, LPC
• Jami Cook Bartholomew, FNP
• Julie Beal, OT
• Electra K Beard, FNP-C
• Thomas Bass Beasley, MD
• Beauty for Ashes Counseling Services LLC
• Frederick Sancheze Beene, PT

• Psychiatry Physician in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.