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General NPI Number Information
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NPI Number | 1285899930
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Entity Type | Individual
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Provider Name | MARY SHEREE BAILEY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1855 CRANE RIDGE DR STE C
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City | JACKSON
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State | MS
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Zip | 39216-4944
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Country | US
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Telephone | 769-218-8298
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Fax | 769-207-7269
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Provider Business Mailing Address
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Address Line | 1855 CRANE RIDGE DR SUITE C
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City | MADISON
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State | MS
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Zip | 39110-7730
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Country | US
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Telephone | 769-218-8298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1824
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 641193
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License Number State | MS
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