Provider Demographics
NPI:1053642785
Name:DEBERRY, BOBBY L (BA)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:L
Last Name:DEBERRY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2096
Mailing Address - Country:US
Mailing Address - Phone:731-967-8803
Mailing Address - Fax:731-967-8784
Practice Address - Street 1:335 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2096
Practice Address - Country:US
Practice Address - Phone:731-967-8803
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor