Provider Demographics
NPI:1407087281
Name:BAILEY, GERALD B JR (DD, CPM)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:B
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:DD, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 RAY WHITE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-9104
Mailing Address - Country:US
Mailing Address - Phone:817-745-4673
Mailing Address - Fax:817-745-4674
Practice Address - Street 1:9500 RAY WHITE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-9104
Practice Address - Country:US
Practice Address - Phone:817-745-4673
Practice Address - Fax:817-745-4674
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
TX101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist