Provider Demographics
NPI:1891337374
Name:COE, BAILEY TYLER
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:TYLER
Last Name:COE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1663
Mailing Address - Country:US
Mailing Address - Phone:831-420-1020
Mailing Address - Fax:831-420-1057
Practice Address - Street 1:2115 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1663
Practice Address - Country:US
Practice Address - Phone:831-420-1020
Practice Address - Fax:831-420-1057
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health