MEDICARE: MS. MARY LOUISE BARKSDALE MCP, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC 0520	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MS LPC 0620	OTHER	MS	GROUP NUMBER

General Provider Information

NPI Number	:	1538295761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LOUISE BARKSDALE MCP, LPC, NCC

Provider Business Mailing Address
First Line	:	784 PINEHURST PL
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-1737
Country	:	US
Telephone Number	:	601-969-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	357 TOWNE CENTER BLVD
Second Line	:	SUITE 402
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4837
Country	:	US
Telephone Number	:	601-952-0515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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