| Organization Name: | PSYCAMORE, LLC |
| NPI Number: | 1003195967 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHERINE A HALL (DIRECTOR, BUSINESS OPERATIONS) |
| Mailing Address: | 243 Beauvoir Rd Suite B Biloxi |
| State: | MS US |
| Postal Code: | 395314008 |
| Phone Number: | 6019395993 |
| Fax Number: | 6019395935 |
| NPI Enumeration Date: | 08/10/2011 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | DCS-PSYCAMORE-PHA-01 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |