Provider Demographics
NPI:1083765507
Name:BAYLESS, CHRISTINE JOY (LPC, CACIII)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOY
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 WHITE ROCK CIR APT F
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6717
Mailing Address - Country:US
Mailing Address - Phone:720-562-0528
Mailing Address - Fax:
Practice Address - Street 1:500 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4598
Practice Address - Country:US
Practice Address - Phone:720-938-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6662101YA0400X
CO4653101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)