Provider Demographics
NPI:1316119100
Name:NEBE, MARY BAYLY I (M ED)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BAYLY
Last Name:NEBE
Suffix:I
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 E LEHIGH DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4609
Mailing Address - Country:US
Mailing Address - Phone:520-584-5146
Mailing Address - Fax:520-584-5101
Practice Address - Street 1:6606 E LEHIGH DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4609
Practice Address - Country:US
Practice Address - Phone:520-584-5146
Practice Address - Fax:520-584-5101
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2558130101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108624Medicaid