Provider Demographics
NPI:1356186530
Name:BAILEY, ALEXIS (MS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CROSS CREEK PKWY APT 1203
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-4442
Mailing Address - Country:US
Mailing Address - Phone:601-320-8908
Mailing Address - Fax:
Practice Address - Street 1:615 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3835
Practice Address - Country:US
Practice Address - Phone:601-336-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health