Provider Demographics
NPI:1790926863
Name:BAILEY, ANDREA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BRADY
Mailing Address - Street 1:972 CHAMBERS ST
Mailing Address - Street 2:STE 5
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4872
Mailing Address - Country:US
Mailing Address - Phone:801-397-4166
Mailing Address - Fax:801-397-4195
Practice Address - Street 1:350 E. 300 S.
Practice Address - Street 2:#100 ROCKY MOUNTAIN CARE
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-397-4166
Practice Address - Fax:801-397-4195
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT283182-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor