Provider Demographics
NPI:1538662283
Name:BAYLESS, GREGORY TODD
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:TODD
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8646 CARBON PLANT RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-9289
Mailing Address - Country:US
Mailing Address - Phone:318-381-3739
Mailing Address - Fax:
Practice Address - Street 1:107 MILLER ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241
Practice Address - Country:US
Practice Address - Phone:318-368-4755
Practice Address - Fax:318-982-8050
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician