Provider Demographics
NPI:1518046267
Name:BAILEY, DUSTIN N (LPC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:N
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 CRAIG RD STE 102C
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7122
Mailing Address - Country:US
Mailing Address - Phone:314-662-4403
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD STE 102C
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-662-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003032164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497543801Medicaid