Provider Demographics
NPI:1407132996
Name:BAILEY, LARRY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CONROE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1950
Mailing Address - Country:US
Mailing Address - Phone:936-444-3546
Mailing Address - Fax:936-760-9101
Practice Address - Street 1:212 CONROE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1950
Practice Address - Country:US
Practice Address - Phone:936-444-3546
Practice Address - Fax:936-760-9101
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional