Provider Demographics
NPI:1538295761
Name:BARKSDALE, MARY LOUISE (MCP, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:MCP, LPC, NCC
Other - Prefix:
Other - First Name:BUDDIE
Other - Middle Name:
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:784 PINEHURST PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1737
Mailing Address - Country:US
Mailing Address - Phone:601-969-7667
Mailing Address - Fax:
Practice Address - Street 1:357 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4837
Practice Address - Country:US
Practice Address - Phone:601-952-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLPC 0520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSMS LPC 0620OtherGROUP NUMBER