Provider Demographics
NPI:1760255343
Name:BAILEY, TAMMI (MED)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4838
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4838
Mailing Address - Country:US
Mailing Address - Phone:304-896-4590
Mailing Address - Fax:
Practice Address - Street 1:467 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-2200
Practice Address - Country:US
Practice Address - Phone:304-369-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty