Provider Demographics
NPI:1710396577
Name:BAILEY, MICHELLE (LLMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1135
Mailing Address - Country:US
Mailing Address - Phone:323-426-6173
Mailing Address - Fax:
Practice Address - Street 1:900 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1135
Practice Address - Country:US
Practice Address - Phone:323-426-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker