Provider Demographics
NPI:1013348390
Name:BAIZE, GREGORY LEE SR (MPSYCH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:BAIZE
Suffix:SR
Gender:M
Credentials:MPSYCH
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Mailing Address - Street 1:2400 FRIENDSHIP DRIVE, SUITE B
Mailing Address - Street 2:RONALD LOGSDON COMMUNITY CENTER AT PRESIDENTS PLACE
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3011
Mailing Address - Country:US
Mailing Address - Phone:270-852-6516
Mailing Address - Fax:270-683-9771
Practice Address - Street 1:2400 FRIENDSHIP DRIVE, SUITE B
Practice Address - Street 2:RONALD LOGSDON COMMUNITY CENTER AT PRESIDENTS PLACE
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3011
Practice Address - Country:US
Practice Address - Phone:270-852-6516
Practice Address - Fax:270-683-9771
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY2785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health