Provider Demographics
NPI:1013686740
Name:BAILEY, RONALD WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 SAND VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2803
Mailing Address - Country:US
Mailing Address - Phone:580-297-3618
Mailing Address - Fax:
Practice Address - Street 1:MILLENNIUM MEDICAL SERVICES
Practice Address - Street 2:312 N. VAN BUREN ST
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703
Practice Address - Country:US
Practice Address - Phone:580-297-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8098P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical