Individual ProviderKim L. GratzPsychologistBehavioral Health & Social Service ProvidersPractice Address2500 N State St, H801, Department Of Psychiatry, Jackson, MS 39216-4500(601) 815-6450PECOS EnrollmentBased on the most recent information from CMS, provider Kim L. Gratz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1598905218Provider TypeIndividualFull NameGratz, Kim L.TitleDr.CredentialPH.D.GenderFemaleSole ProprietorNoEnumeration Date2/21/2009Last Updated6/29/2012Contact InformationPractice LocationPractice Address2500 N State St, H801, Department Of Psychiatry, Jackson, MS 39216-4500Phone(601) 815-6450Fax(601) 984-4489Mailing LocationMailing Address2500 N State St, H801, Department Of Psychiatry, Jackson, MS 39216-4500Phone(601) 815-6450Fax(601) 984-4489Provider TaxonomiesCodeDescriptionLicenseCode103TC0700XPrimaryDescriptionPsychologistBehavioral Health & Social Service ProvidersLicense48 831MississippiProvider IdentifiersIDDescriptionIssuerID302I680217DescriptionOtherIssuerMEDICARE PTANMississippi