Provider Demographics
NPI: | 1255309530 |
---|---|
Name: | BAILEY, LINDA (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | LINDA |
Middle Name: | |
Last Name: | BAILEY |
Suffix: | |
Gender: | F |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 9700 PARK PLAZA AVE |
Mailing Address - Street 2: | STE 105 |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40241-2286 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-327-0209 |
Mailing Address - Fax: | 502-426-4902 |
Practice Address - Street 1: | 9700 PARK PLAZA AVE |
Practice Address - Street 2: | STE 105 |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40241-2286 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-327-0209 |
Practice Address - Fax: | 502-426-4902 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-10 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 78519 | 103T00000X |
KY | 361 | 104100000X |
KY | 0308 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
Not Answered | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
Not Answered | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |