1255464566 NPI number — MS. EMILY ELIZABETH BAILEY LPC

Table of content: MS. EMILY ELIZABETH BAILEY LPC (NPI 1255464566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255464566 NPI number — MS. EMILY ELIZABETH BAILEY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
EMILY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAYNOR
Provider Other First Name:
EMILY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255464566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342 BURROW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTON VALLEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71018-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
183-510-4784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7505 PINES RD STE 1115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71129-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-683-4086
Provider Business Practice Location Address Fax Number:
318-623-4087
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  6385 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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