Provider Demographics
NPI:1609330844
Name:BAILEY, MATTHEW (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 NORTHBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8917
Mailing Address - Country:US
Mailing Address - Phone:713-309-5246
Mailing Address - Fax:
Practice Address - Street 1:8900 EASTLOCH DR STE 220-K
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2337
Practice Address - Country:US
Practice Address - Phone:713-309-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional