Provider Demographics
NPI:1255578324
Name:BAILEY, STEPHEN DOUGLAS (ED D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:ED D
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 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-315-7910
Mailing Address - Fax:928-722-6113
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-6329
Practice Address - Country:US
Practice Address - Phone:928-627-1120
Practice Address - Fax:928-722-6113
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3803103G00000X
AL1253103G00000X
AZPSY-003803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554207Medicare PIN