Provider Demographics
NPI:1225780380
Name:GONZALES, BAILEY MICHELLE (CADC-I)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:MICHELLE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:MICHELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1657 US HIGHWAY 395 N
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4316
Mailing Address - Country:US
Mailing Address - Phone:775-265-8622
Mailing Address - Fax:
Practice Address - Street 1:1657 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4316
Practice Address - Country:US
Practice Address - Phone:775-265-8622
Practice Address - Fax:775-265-5027
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07205-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty