Provider Demographics
NPI:1275192098
Name:BAILEY, BECKY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-2229
Mailing Address - Country:US
Mailing Address - Phone:208-880-3934
Mailing Address - Fax:
Practice Address - Street 1:4477 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2000
Practice Address - Country:US
Practice Address - Phone:208-321-0160
Practice Address - Fax:208-321-0221
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID433751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical