Provider Demographics
NPI:1356489926
Name:NORBURY, GAYLE SHARYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:SHARYN
Last Name:NORBURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:0
Other - Middle Name:
Other - Last Name:0
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:605 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-0000
Practice Address - Country:US
Practice Address - Phone:601-450-0310
Practice Address - Fax:601-450-0231
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS46752103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09138763Medicaid