Provider Demographics
NPI:1871358184
Name:COMMUNITY MENTAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:COMMUNITY MENTAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:JATON
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-665-7983
Mailing Address - Street 1:1393 OLD PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9468
Mailing Address - Country:US
Mailing Address - Phone:601-665-7983
Mailing Address - Fax:
Practice Address - Street 1:200 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5134
Practice Address - Country:US
Practice Address - Phone:601-665-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health