Provider Demographics
NPI:1073841847
Name:BAILEY, IRIS LYNN (LPCC-S)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5701
Mailing Address - Country:US
Mailing Address - Phone:216-360-9343
Mailing Address - Fax:216-360-9345
Practice Address - Street 1:4517 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5701
Practice Address - Country:US
Practice Address - Phone:216-360-9343
Practice Address - Fax:216-360-9345
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0500778101YA0400X, 101YM0800X
OHE0500778101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055659Medicaid