Provider Demographics
NPI:1093392094
Name:BAILEY, ANNA CAROLINA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CAROLINA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 21ST AVE N STE 12
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4323
Mailing Address - Country:US
Mailing Address - Phone:320-247-4845
Mailing Address - Fax:
Practice Address - Street 1:5 21ST AVE N STE 12
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4323
Practice Address - Country:US
Practice Address - Phone:320-247-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist