Provider Demographics
NPI:1497807598
Name:BAILEY, GORDON ARTHUR (LMHC)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:ARTHUR
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886
Mailing Address - Country:US
Mailing Address - Phone:978-692-8514
Mailing Address - Fax:
Practice Address - Street 1:10 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1201
Practice Address - Country:US
Practice Address - Phone:978-453-5736
Practice Address - Fax:978-970-5595
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health