Provider Demographics
NPI:1164464277
Name:BAILEY, BETH LOUISE (CADC III, LPC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:LOUISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CADC III, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-0579
Mailing Address - Country:US
Mailing Address - Phone:541-766-6238
Mailing Address - Fax:
Practice Address - Street 1:555 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6418
Practice Address - Country:US
Practice Address - Phone:541-757-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10963101YA0400X
AZLPC-11732101YP2500X
OR07-R-16101YA0400X
ORLPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084198OtherAHCCCS #
OR50531 11292799-1AOtherBENTON COUNTY EMPLOYEE NUMBER