Organization Name: | PSYCAMORE, LLC |
NPI Number: | 1043465040 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY LICHTE-MADAKASIRA (VICE-PRESIDENT) |
Mailing Address: | 7165 Getwell Rd Building 3, Suite 1 & 2 Southaven |
State: | MS US |
Postal Code: | 386729659 |
Phone Number: | 8007792448 |
Fax Number: | 6019935935 |
NPI Enumeration Date: | 11/19/2008 |
NPI Last Update Date: | 11/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |