Provider Demographics
NPI:1922792217
Name:BAYLOR, BRIANNA KRESS CAREY (MFT-IT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KRESS CAREY
Last Name:BAYLOR
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KESSEL CT APT 3
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6234
Mailing Address - Country:US
Mailing Address - Phone:630-656-4863
Mailing Address - Fax:
Practice Address - Street 1:1001 FOURIER DR STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1958
Practice Address - Country:US
Practice Address - Phone:608-301-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106H1033228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist