Provider Demographics
NPI:1568709277
Name:BAIRLEY, REBECCA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BAIRLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44097 RIVERGATE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1366
Mailing Address - Country:US
Mailing Address - Phone:586-286-6071
Mailing Address - Fax:
Practice Address - Street 1:35455 GARFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-792-5335
Practice Address - Fax:586-792-3016
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional