Provider Demographics
NPI:1760596043
Name:BAILEY, JANET M (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:BAILEY
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 1:2074 GALISTEO ST STE A1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2104
Mailing Address - Country:US
Mailing Address - Phone:505-474-3481
Mailing Address - Fax:505-474-3451
Practice Address - Street 1:2074 GALISTEO ST STE A1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2104
Practice Address - Country:US
Practice Address - Phone:505-474-3481
Practice Address - Fax:505-474-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N3804Medicaid