Datz, Geralyn

Datz, Geralyn is an sole proprietor health care provider with primary practice located at 1 Commerce Dr Ste 205, Hattiesburg MS 39402-1499. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Health. Behavioral Health & Social Service Providers / Health is her primary health care specialty. Datz, Geralyn can be contacted via phone (601) 255-1618.

Contact Information

Primary practice address
1 Commerce Dr Ste 205 Hattiesburg MS 39402-1499
Phone: (601) 255-1618
Fax: (601) 255-1619
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 45736 Mississippi
Behavioral Health & Social Service Providers / Health 103TH0004X 45-736 Mississippi
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1140 Louisiana
Behavioral Health & Social Service Providers / Health 103TH0004X 1140 Louisiana

Profile Details

NPI number 1972616076
LBN Legal business name Datz, Geralyn
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 16th, 2006
Last updated Nov 30th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972616076 NPPES
Alabama MEDICAID 009933077
Alabama MEDICAID 06036275

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