Provider Demographics
NPI:1275074122
Name:BAILEY, TIERRA
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:BAILEY
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 1:2840 SHADOWBRIAR DR
Mailing Address - Street 2:505
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3268
Mailing Address - Country:US
Mailing Address - Phone:832-574-2138
Mailing Address - Fax:
Practice Address - Street 1:2840 SHADOWBRIAR DR
Practice Address - Street 2:505
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3268
Practice Address - Country:US
Practice Address - Phone:832-574-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness