Provider Demographics
NPI:1396405403
Name:BAILEY-MORE, MARY CHALICE (CCP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHALICE
Last Name:BAILEY-MORE
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3709
Mailing Address - Country:US
Mailing Address - Phone:713-302-0745
Mailing Address - Fax:
Practice Address - Street 1:4515 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3709
Practice Address - Country:US
Practice Address - Phone:713-302-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFPF00000049242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist