Provider Demographics
NPI:1295608339
Name:POLEY, MARY LOUISE (LMHC INTERN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:POLEY
Suffix:
Gender:F
Credentials:LMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5166 HIGHWAY 182
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-9357
Mailing Address - Country:US
Mailing Address - Phone:850-910-1326
Mailing Address - Fax:
Practice Address - Street 1:5166 HIGHWAY 182
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-9357
Practice Address - Country:US
Practice Address - Phone:850-910-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH28102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health