Provider Demographics
NPI:1104547652
Name:BAILEY, LORI RENEE MCCALLUM (MHA, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENEE MCCALLUM
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MHA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42902 BERKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4040
Mailing Address - Country:US
Mailing Address - Phone:619-723-6205
Mailing Address - Fax:
Practice Address - Street 1:42902 BERKLEY AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4040
Practice Address - Country:US
Practice Address - Phone:619-723-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1246651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical