Provider Demographics
NPI:1376802629
Name:BAILEY, GREGORY ALLEN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-0005
Mailing Address - Country:US
Mailing Address - Phone:580-235-5305
Mailing Address - Fax:
Practice Address - Street 1:821 E WYNNEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4072
Practice Address - Country:US
Practice Address - Phone:580-235-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker