Provider Demographics
NPI:1497939862
Name:BAILEY, TRAVIS LEE (CADC-II, ICADC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:CADC-II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 SHALE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8880
Mailing Address - Country:US
Mailing Address - Phone:530-855-1917
Mailing Address - Fax:530-885-1169
Practice Address - Street 1:12125 SHALE RIDGE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8880
Practice Address - Country:US
Practice Address - Phone:530-855-1917
Practice Address - Fax:530-885-1169
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA01990315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)