Provider Demographics
NPI:1346983194
Name:BAILEY, DANA TATE
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:TATE
Last Name:BAILEY
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 1:134 TISHOMINGO TRL
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-8828
Mailing Address - Country:US
Mailing Address - Phone:662-316-5482
Mailing Address - Fax:
Practice Address - Street 1:134 TISHOMINGO TRL
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-8828
Practice Address - Country:US
Practice Address - Phone:662-316-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health