Provider Demographics
NPI:1275661035
Name:BAYLESS, SHANEEN W (MENTAL HEALTH WORKER)
Entity Type:Individual
Prefix:MS
First Name:SHANEEN
Middle Name:W
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:MENTAL HEALTH WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E CARSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2866
Mailing Address - Country:US
Mailing Address - Phone:530-458-0520
Mailing Address - Fax:
Practice Address - Street 1:162 E CARSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2866
Practice Address - Country:US
Practice Address - Phone:530-458-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health