=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093923773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LADYE HARRIETT DOYLE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 N STATE ST SUITE 100
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39202-1689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-213-9588
-----------------------------------------------------
Fax | 601-944-9770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 WOODRUN DR
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-213-9588
-----------------------------------------------------
Fax | 601-944-9770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C7280
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------