Provider Demographics
NPI:1801040282
Name:BAILEY, MALINDA ANN (BA)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:ANN
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1404
Mailing Address - Country:US
Mailing Address - Phone:918-423-6030
Mailing Address - Fax:918-423-2370
Practice Address - Street 1:309 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4047
Practice Address - Country:US
Practice Address - Phone:918-465-3381
Practice Address - Fax:918-465-3053
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)