Provider Demographics
NPI:1164561973
Name:HANIGAN BAILY, GWENDOLYN FAYE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:FAYE
Last Name:HANIGAN BAILY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 S PRIEST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1915
Mailing Address - Country:US
Mailing Address - Phone:480-838-7273
Mailing Address - Fax:480-704-0083
Practice Address - Street 1:8727 S PRIEST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1915
Practice Address - Country:US
Practice Address - Phone:480-838-7273
Practice Address - Fax:480-704-0083
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC28647OtherNATIONAL BOARD CERTIFIED
AZLPC0511OtherLICENSE