Provider Demographics
NPI:1336174176
Name:BAILEY, ROBERT (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 W MARCH LN
Mailing Address - Street 2:SUITE D200
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6652
Mailing Address - Country:US
Mailing Address - Phone:209-951-3322
Mailing Address - Fax:209-951-0448
Practice Address - Street 1:2291 W MARCH LN
Practice Address - Street 2:SUITE D200
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6652
Practice Address - Country:US
Practice Address - Phone:209-951-3322
Practice Address - Fax:209-951-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist