Provider Demographics
NPI:1902578982
Name:MIND WORKS PSYCHIATRY
Entity Type:Organization
Organization Name:MIND WORKS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-530-5287
Mailing Address - Street 1:301 MORRIS GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-2689
Mailing Address - Country:US
Mailing Address - Phone:601-530-5287
Mailing Address - Fax:
Practice Address - Street 1:301 MORRIS GREEN RD
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-2689
Practice Address - Country:US
Practice Address - Phone:601-530-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:F.MCNEIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407239262OtherNPI