PINE BELT MENTAL HEALTHCARE RESOURCES
NPI 1861645657
Pharmacy - Community/Retail Pharmacy in Hattiesburg, MS

Q: What is Region 12 Commission On Mental Health & Retardation Pine's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since October 24, 2008CLIA 25D1083874 · Waiver

103 S 19TH AVE, HATTIESBURG, MS 39401(601) 544-4641(601) 450-4632 Get Directions Write a Review

NPPES record last updated: February 16, 2017. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Pine Belt Mental Healthcare Resources NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PINE BELT MENTAL HEALTHCARE RESOURCES (NPI 1861645657) is a healthcare organization registered as a community/retail pharmacy in Hattiesburg, Mississippi and active in the NPI registry since October 2008. The organization holds a CLIA Waiver certificate valid through May 11, 2028 and lists Jerry Mayo, Ceo, as its authorized official.

NPPES Registry Identity

NPI1861645657

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameREGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE

Location Address103 S 19TH AVEHattiesburg, MS 39401-6171

Mailing Address103 S 19th AveHattiesburg, MS 39401-6171 · (601) 544-4641 · Fax (601) 450-4632

Phone(601) 544-4641

Fax(601) 450-4632

Organization SubpartNo

Authorized OfficialJerry MayoCeo · (601) 544-4641

Enumeration DateOctober 24, 2008

Last NPPES UpdateFebruary 16, 2017

✔ NPI 1861645657 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in MS · 07864/5.1

Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Also ListedPharmacyTaxonomy 333600000X

103 S 19TH AVE, Hattiesburg, MS 39401

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Other Names 1

Doing Business AsPine Belt Mental Healthcare Resources

Other Identifiers 1

Other2117558Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D1083874

Pinebelt Mental Healthcare Resources · Hattiesburg, MS

Active · expires May 11, 2028

CLIA Number25D1083874

Laboratory TypeHealth Fair

Certificate Effective DateMay 12, 2026

Certificate Expiration DateMay 11, 2028

Laboratory DirectorJerry Mayo

Laboratory Phone(601) 544-4641

Laboratory LocationPinebelt Mental Healthcare Resources103 South 19th Avenue, Hattiesburg, MS 39401

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RAYMOND L STRUCK M.D.

Psychiatry & Neurology (Psychiatry)