Provider Demographics
NPI:1518635101
Name:BERKNER, BAYLEE JACE
Entity Type:Individual
Prefix:
First Name:BAYLEE
Middle Name:JACE
Last Name:BERKNER
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 1:6055 LAKESIDE COMMONS DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5791
Mailing Address - Country:US
Mailing Address - Phone:478-238-9344
Mailing Address - Fax:478-225-0566
Practice Address - Street 1:6055 LAKESIDE COMMONS DR STE 320
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5791
Practice Address - Country:US
Practice Address - Phone:478-238-9344
Practice Address - Fax:478-225-0566
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty