Provider Demographics
NPI:1629651401
Name:BAIR, MICAH BRITTANI MASSEY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:BRITTANI MASSEY
Last Name:BAIR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-6702
Mailing Address - Country:US
Mailing Address - Phone:502-295-0274
Mailing Address - Fax:
Practice Address - Street 1:5814 HIGHWAY 348
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425-9714
Practice Address - Country:US
Practice Address - Phone:970-323-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001872106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist