Provider Demographics
NPI:1578807574
Name:BAILEY, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BAILEY
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 1:603 FORD RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-8035
Mailing Address - Country:US
Mailing Address - Phone:870-345-8206
Mailing Address - Fax:501-325-7938
Practice Address - Street 1:205 INGRAM BLVD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3423
Practice Address - Country:US
Practice Address - Phone:870-739-6818
Practice Address - Fax:870-662-6826
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator