Provider Demographics
NPI:1891246229
Name:BAILEY, DEBRA DOUP (LPCCS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DOUP
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-352-6460
Mailing Address - Fax:419-352-3407
Practice Address - Street 1:1033 DEVLAC GRV
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4501
Practice Address - Country:US
Practice Address - Phone:419-352-6460
Practice Address - Fax:419-352-3407
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131104101YA0400X
OHE.0602259SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)