Provider Demographics
NPI:1952662751
Name:BAILLIE, JONATHON C (MS LPC)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:C
Last Name:BAILLIE
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EMERYVILLE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5020
Mailing Address - Country:US
Mailing Address - Phone:724-609-5002
Mailing Address - Fax:307-734-0017
Practice Address - Street 1:125 EMERYVILLE DR STE 230
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5020
Practice Address - Country:US
Practice Address - Phone:724-609-5002
Practice Address - Fax:307-734-0017
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY677101Y00000X
WY1392101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor