Provider Demographics
NPI:1255963583
Name:BAILEY, JAMEY RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:RICHARD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DEVONSHIRE DRIVE, BLDG C
Mailing Address - Street 2:SUITE 206, C-6
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:217-722-2450
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DRIVE, BLDG C
Practice Address - Street 2:SUITE 206, C-6
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-722-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490209581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical