Provider Demographics
NPI:1215280631
Name:BAILEY, LAURA M (MS, LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-0668
Mailing Address - Country:US
Mailing Address - Phone:304-926-9575
Mailing Address - Fax:530-387-5641
Practice Address - Street 1:3430 ROBIN LN STE 3A
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8441
Practice Address - Country:US
Practice Address - Phone:530-492-6957
Practice Address - Fax:530-387-5641
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006496106H00000X
CALMFT86284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist