Provider Demographics
NPI:1700016151
Name:SLY, KAYE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAYE
Middle Name:
Last Name:SLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-8611
Mailing Address - Country:US
Mailing Address - Phone:601-979-8857
Mailing Address - Fax:601-979-8860
Practice Address - Street 1:101 SAGE HILLS DR
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-8611
Practice Address - Country:US
Practice Address - Phone:601-979-8857
Practice Address - Fax:601-979-8860
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS36651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical