Provider Demographics
NPI:1265547863
Name:BAILEY, MARYLOU CAROL (LMFT)
Entity type:Individual
Prefix:
First Name:MARYLOU
Middle Name:CAROL
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3327
Mailing Address - Country:US
Mailing Address - Phone:916-451-2567
Mailing Address - Fax:
Practice Address - Street 1:874 57TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3327
Practice Address - Country:US
Practice Address - Phone:916-451-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist