Provider Demographics
NPI:1548741408
Name:BAILEY, BRANDY (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 AHTANUM RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-9401
Mailing Address - Country:US
Mailing Address - Phone:509-388-1436
Mailing Address - Fax:
Practice Address - Street 1:8110 AHTANUM RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-9401
Practice Address - Country:US
Practice Address - Phone:509-388-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60597065101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)