Provider Demographics
NPI:1619629003
Name:ZACHARY, BAILEY W (PLPC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:W
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6543
Mailing Address - Country:US
Mailing Address - Phone:225-408-6060
Mailing Address - Fax:225-408-7410
Practice Address - Street 1:8416 CUMBERLAND PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6543
Practice Address - Country:US
Practice Address - Phone:225-408-6060
Practice Address - Fax:225-408-7410
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8934101YM0800X, 171M00000X, 101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)