Provider Demographics
NPI:1356173371
Name:BAISLEY COUNSELING GROUP LLC
Entity type:Organization
Organization Name:BAISLEY COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:205-973-1022
Mailing Address - Street 1:5300 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-6702
Mailing Address - Country:US
Mailing Address - Phone:205-973-1022
Mailing Address - Fax:
Practice Address - Street 1:5300 AVERY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-6702
Practice Address - Country:US
Practice Address - Phone:205-973-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health