Provider Demographics
NPI:1083648612
Name:BAILEY, KATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 NORTH FIELDER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4661
Mailing Address - Country:US
Mailing Address - Phone:817-275-5525
Mailing Address - Fax:817-275-0082
Practice Address - Street 1:721 NORTH FIELDER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4661
Practice Address - Country:US
Practice Address - Phone:817-275-5525
Practice Address - Fax:817-275-0082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1790101YP2500X
TX2213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist