Provider Demographics
NPI:1821363540
Name:BAILEY MASON ENTERPRISES, INC
Entity Type:Organization
Organization Name:BAILEY MASON ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-931-6450
Mailing Address - Street 1:7711 NE 175TH ST UNIT D205
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3585
Mailing Address - Country:US
Mailing Address - Phone:425-931-6450
Mailing Address - Fax:888-240-5967
Practice Address - Street 1:3429 FREMONT PL N STE 315
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8661
Practice Address - Country:US
Practice Address - Phone:425-931-6450
Practice Address - Fax:888-240-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60252354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty