Provider Demographics
NPI:1386656684
Name:BAILEY, MICKEY RONALD (MS)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:RONALD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 NORTHLINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6376
Mailing Address - Country:US
Mailing Address - Phone:501-257-4115
Mailing Address - Fax:501-257-4116
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:116
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-4115
Practice Address - Fax:501-257-4116
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101Y00000XOtherCOUNSELOR