Provider Demographics
NPI:1952440059
Name:BAILEY, KIM (LPC, LMFT, SAP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC, LMFT, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST STE 510D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4526
Mailing Address - Country:US
Mailing Address - Phone:318-286-8501
Mailing Address - Fax:318-606-2038
Practice Address - Street 1:820 JORDAN ST STE 510D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4526
Practice Address - Country:US
Practice Address - Phone:318-286-8501
Practice Address - Fax:318-606-2038
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218106H00000X
LA1740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist