Provider Demographics
NPI:1184945677
Name:BAYLY, DAN JAMES (LPC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:JAMES
Last Name:BAYLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S ASBURY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2243
Mailing Address - Country:US
Mailing Address - Phone:208-882-2566
Mailing Address - Fax:888-972-5312
Practice Address - Street 1:530 S ASBURY ST STE 4
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2243
Practice Address - Country:US
Practice Address - Phone:208-882-2566
Practice Address - Fax:888-972-5312
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4442101Y00000X, 101YA0400X, 101YM0800X
IDLCPC-4868101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health