Provider Demographics
NPI:1538462874
Name:BECKY BAILEY, PH.D., PC
Entity Type:Organization
Organization Name:BECKY BAILEY, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-521-6234
Mailing Address - Street 1:699 E SOUTH TEMPLE STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-4251
Mailing Address - Country:US
Mailing Address - Phone:801-521-6234
Mailing Address - Fax:801-257-0528
Practice Address - Street 1:699 E SOUTH TEMPLE STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4251
Practice Address - Country:US
Practice Address - Phone:801-521-6234
Practice Address - Fax:801-257-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1156592501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT543625594011Medicaid
UTU000007440Medicare UPIN