Provider Demographics
NPI:1548093545
Name:MISSISSIPPI BAND OF CHOCTAW INDIANS
Entity type:Organization
Organization Name:MISSISSIPPI BAND OF CHOCTAW INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXPRESSIVE ART SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PYAWASIT-VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:P-LPAT
Authorized Official - Phone:601-389-4150
Mailing Address - Street 1:210 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:MS
Mailing Address - Zip Code:39350-6781
Mailing Address - Country:US
Mailing Address - Phone:601-389-4147
Mailing Address - Fax:
Practice Address - Street 1:210 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:MS
Practice Address - Zip Code:39350-6781
Practice Address - Country:US
Practice Address - Phone:601-389-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty