OrganizationActive
Region 8 Mh/Mr Commission
NPI 1306178694 · Intellectual & Developmental Disabilities Psychologist · Brandon, MS
Provider details
- NPI number
- 1306178694
- Entity type
- Organization
- Primary specialty
- Intellectual & Developmental Disabilities PsychologistBehavioral Health & Social Service Providers
- Authorized official
- Dave Van, Executive Director
- License
- R08-BMR-WAC-PREVOC-0 (MS)
Practice location
613 Marquette Road
Brandon, MS 39042
Phone: (601) 824-0342
Fax: (601) 824-0349
Mailing address
Po Box 88
Brandon, MS 39042
Registry dates
- Enumerated
- 2010-02-11
- Last updated
- 2022-06-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.