Provider Demographics
NPI:1235724238
Name:MISSION BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:MISSION BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SPIKES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-698-0135
Mailing Address - Street 1:3479 COUNTY ROAD 94
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-4845
Mailing Address - Country:US
Mailing Address - Phone:256-698-0135
Mailing Address - Fax:
Practice Address - Street 1:3479 COUNTY ROAD 94
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-4845
Practice Address - Country:US
Practice Address - Phone:256-698-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty