Provider Demographics
NPI:1043099674
Name:PYBUS, LADONNA
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:
Last Name:PYBUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 RAMER SELMER RD
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-5441
Mailing Address - Country:US
Mailing Address - Phone:469-855-4804
Mailing Address - Fax:
Practice Address - Street 1:806 S PARKWAY ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6563
Practice Address - Country:US
Practice Address - Phone:662-536-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0990101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor