Healthcare Provider Details

I. General information

NPI: 1184033433
Provider Name (Legal Business Name): OLGA SOFIA BAYLES MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 LAKELAND DR
JACKSON MS
39216-4719
US

IV. Provider business mailing address

PO BOX 1078
JACKSON MS
39215-1078
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-7784
  • Fax:
Mailing address:
  • Phone: 601-352-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1673
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: