Indianola Clinic, LLC

NPI #1164964565 in Leland, Mississippi

Provider Information

NPI Number
1164964565
Entity Type
Organization
Organization Name
Indianola Clinic, LLC
Primary Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date
Nov 16, 2016
Last Updated
May 18, 2017

Practice Location

Address
201 BAKER BLVD
City
Leland
ZIP Code
38756-3401
Phone
(662) 686-4121

Authorized Official

Name
MR. HENRY MARLIN WOMACK JR.
Title
VP OF ADMINISTRATION
Phone
(662) 686-3916

Specialties & Taxonomy Codes

Specialty
Counselor
Social Worker
Clinic/Center - Mental Health (Including Community Mental Health Center)Mental Health (Including Community Mental Health Center)

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