Provider Demographics
NPI:1679768287
Name:THE SHEPHERD'S STAFF
Entity type:Organization
Organization Name:THE SHEPHERD'S STAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-664-0455
Mailing Address - Street 1:2508 LAKELAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9502
Mailing Address - Country:US
Mailing Address - Phone:601-664-0455
Mailing Address - Fax:601-664-1675
Practice Address - Street 1:2508 LAKELAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9502
Practice Address - Country:US
Practice Address - Phone:601-664-0455
Practice Address - Fax:601-664-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty