1982901450 NPI number — MS. JOCELYN MARGARET BAILEY LMHC

Table of content: MS. JOCELYN MARGARET BAILEY LMHC (NPI 1982901450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982901450 NPI number — MS. JOCELYN MARGARET BAILEY LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
JOCELYN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESCH
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982901450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 E. COLFAX AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46617-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-210-8098
Provider Business Mailing Address Fax Number:
574-207-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 E. COLFAX AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46617-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-210-8098
Provider Business Practice Location Address Fax Number:
574-207-0565
Provider Enumeration Date:
02/18/2011

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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