Provider Demographics
NPI:1518445600
Name:BAILEY, JONATHAN ADAM (R139530916)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ADAM
Last Name:BAILEY
Suffix:
Gender:M
Credentials:R139530916
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 L ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4509
Mailing Address - Country:US
Mailing Address - Phone:661-634-9877
Mailing Address - Fax:
Practice Address - Street 1:1304 L ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4509
Practice Address - Country:US
Practice Address - Phone:661-634-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)