Basic Information
Provider Information
NPI: 1013524396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRIGSS
FirstName: CATINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 WHITE ST
Address2:  
City: MCCOMB
State: MS
PostalCode: 396482711
CountryCode: US
TelephoneNumber: 6012494218
FaxNumber: 6012494234
Practice Location
Address1: 1701 WHITE ST
Address2:  
City: MCCOMB
State: MS
PostalCode: 396482711
CountryCode: US
TelephoneNumber: 6012494218
FaxNumber: 6012494234
Other Information
ProviderEnumerationDate: 09/30/2020
LastUpdateDate: 09/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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