Provider Demographics
NPI:1295743151
Name:BAILEY, JAN (LPC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CIEN RD STE 130D
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-3065
Mailing Address - Country:US
Mailing Address - Phone:281-733-0369
Mailing Address - Fax:281-240-6481
Practice Address - Street 1:601 CIEN RD STE 130D
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3065
Practice Address - Country:US
Practice Address - Phone:281-733-0369
Practice Address - Fax:281-240-6481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7169LCOtherBC/BS
TX028924102Medicaid