Provider Demographics
NPI:1629658224
Name:BAILEY, REBECCA (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-4631
Mailing Address - Country:US
Mailing Address - Phone:615-739-8537
Mailing Address - Fax:
Practice Address - Street 1:408 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9201
Practice Address - Country:US
Practice Address - Phone:615-739-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health