Provider Demographics
NPI:1760695068
Name:BAILEY, DIANE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 MORNING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-1516
Mailing Address - Country:US
Mailing Address - Phone:281-642-2877
Mailing Address - Fax:281-996-7420
Practice Address - Street 1:2428 MORNING RIDGE LN
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-1516
Practice Address - Country:US
Practice Address - Phone:281-642-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22839103TC0700X
TX2-2839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098476701Medicaid