Provider Demographics
NPI:1639786890
Name:BAILON, JULIANDRA (MS, LASAC)
Entity Type:Individual
Prefix:
First Name:JULIANDRA
Middle Name:
Last Name:BAILON
Suffix:
Gender:F
Credentials:MS, LASAC
Other - Prefix:
Other - First Name:JULES
Other - Middle Name:
Other - Last Name:BLUE BAILON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LASAC
Mailing Address - Street 1:483 W SEED FARM RD
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-5000
Mailing Address - Country:US
Mailing Address - Phone:520-610-3927
Mailing Address - Fax:
Practice Address - Street 1:483 W SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-5000
Practice Address - Country:US
Practice Address - Phone:520-610-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)