Provider Demographics
NPI:1467179804
Name:BAILEY, PAMELA LEE (CHT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 N CASCADE AVE LOT 23
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5230
Mailing Address - Country:US
Mailing Address - Phone:719-243-3915
Mailing Address - Fax:
Practice Address - Street 1:3841 N CASCADE AVE LOT 23
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5230
Practice Address - Country:US
Practice Address - Phone:719-243-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty