Provider Demographics
NPI:1922005107
Name:BAYLESS, SCOTT L (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:PHD
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 579048
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-9048
Mailing Address - Country:US
Mailing Address - Phone:209-274-6892
Mailing Address - Fax:209-267-2326
Practice Address - Street 1:1844 SCENIC DR APT 239
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-6026
Practice Address - Country:US
Practice Address - Phone:209-227-4689
Practice Address - Fax:209-227-2326
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2022-02-22
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAPSY13401103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922005107OtherNO OTHER IDENTIFIERS
CAPSY13401OtherSTATE LICENSE