Provider Demographics
NPI:1265786966
Name:BAXLEY, BELINDA JAYNE
Entity type:Individual
Prefix:MISS
First Name:BELINDA
Middle Name:JAYNE
Last Name:BAXLEY
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 1:4101 ANGELUS ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2523
Mailing Address - Country:US
Mailing Address - Phone:870-450-3456
Mailing Address - Fax:
Practice Address - Street 1:830 MILL ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2398
Practice Address - Country:US
Practice Address - Phone:334-435-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193534783Medicaid