Provider Demographics
NPI:1003217894
Name:BAILEY, IESHAI TAWANDA (PHD, CMHC, LMHC, CST)
Entity Type:Individual
Prefix:DR
First Name:IESHAI
Middle Name:TAWANDA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD, CMHC, LMHC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LAKE EMERALD DR APT 405
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6250
Mailing Address - Country:US
Mailing Address - Phone:754-200-1463
Mailing Address - Fax:904-204-3291
Practice Address - Street 1:401 NW 16TH AVENUE N
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6250
Practice Address - Country:US
Practice Address - Phone:904-738-3506
Practice Address - Fax:904-204-3291
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health