SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC (NPI# 1487950564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487950564 |
| Entity Type | Organization |
| Organization Name | SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC |
| Practice Address |
1 Commerce Dr Ste 106 Hattiesburg MS 39402-1499 |
| Mailing Address |
Po Box 18799 Hattiesburg MS 39404-8799 |
| Practice Telephone | 6012551618 |
| Practice Fax Number | 6012551619 |
| Mailing Telephone | 6012551618 |
| Mailing Fax Number | 6012551619 |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2013-01-15 |
| Authorized Official Name | DR. GERALYN DATZ (CLINICAL DIRECTOR/OWNER) |
| Authorized Official Telephone | 6012551618 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 103TH0004X |
Psychologist Specialization: Health |
Behavioral Health & Social Service Providers |
| Street Address |
1 COMMERCE DR STE 106 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402-1499 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972616076 | Geralyn Datz | Psychologist | 1 Commerce Dr, Ste 205, Hattiesburg, MS 39402-1499 | 2006-08-16 |
| 1225303068 | Mindful Solution, LLC | Psychologist | 1 Commerce Dr, Suite 205, Hattiesburg, MS 39402-1499 | 2012-03-13 |
| 1982981247 | Scott Willoughby, Phd, LLC | Psychologist | 1 Commerce Dr, Suite 205, Hattiesburg, MS 39402-1499 | 2011-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| Taxonomy Code | 103TH0004X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health |
| The distinct focus of the clinical health psychologist is on physical health problems. A clinical health psychologist has special expertise or training in clinical health psychology and applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to the promotion and maintenance of health; the prevention, treatment and rehabilitation of illness and disability; and the improvement of the health care system. Clinical health psychologists are dedicated to the development of knowledge regarding the interface between behavior and health, and to the delivery of high quality services based on that knowledge to individuals, families, and health care. |
| Notes: Source: American Psychological Association Commission for the Recognition of Specialties and Proficiencies in Professional Psychology, 2008. [1/1/2007: new, 7/1/2008: definiton added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891003331 | Geralyn Datz Phd | Psychologist | 502 Court St, Hattiesburg, MS 39401-3944 | 2010-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316188121 | Kathryn Kim Waggoner | Psychologist | 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564-3067 | 2009-03-09 |
| 1093366775 | Phoenix Behavioral Health Center, Pllc | Psychologist | 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564-3067 | 2019-09-24 |
| City | HATTIESBURG |
| Zip Code | 39402 |
Please comment or provide details below to improve the information on SOUTHERN BEHAVIORAL MEDICINE ASSOCIATES PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.