Provider Demographics
NPI:1114330164
Name:BAILOUS, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:BAILOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 W CHARLESTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1149
Mailing Address - Country:US
Mailing Address - Phone:702-619-3919
Mailing Address - Fax:
Practice Address - Street 1:6212 W CHARLESTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1149
Practice Address - Country:US
Practice Address - Phone:702-619-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional