Provider Demographics
NPI:1811726987
Name:RALEY, MARY PARKER
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PARKER
Last Name:RALEY
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 1:1600 GOVERNMENT ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1112
Mailing Address - Country:US
Mailing Address - Phone:601-941-1393
Mailing Address - Fax:
Practice Address - Street 1:3929 AIRPORT BLVD STE 2-204
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2241
Practice Address - Country:US
Practice Address - Phone:251-480-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health