Provider Demographics
NPI:1255386314
Name:BAILEY, PATRICIA M (PH D LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PH D LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 12TH STREET
Mailing Address - Street 2:SUITE 307 BOARD OF TRADE BUILDING
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-6988
Mailing Address - Fax:304-242-6951
Practice Address - Street 1:80 12TH STREET
Practice Address - Street 2:SUITE 307 BOARD OF TRADE BUILDING
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-6988
Practice Address - Fax:304-242-6951
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1508101YP2500X
WV802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1062283OtherCOMP VENDER
WV9202160000Medicaid
WV9202160000Medicaid
WV1062283OtherCOMP VENDER
BACP25382Medicare ID - Type UnspecifiedINDIVIDUAL