Provider Demographics
NPI:1356916852
Name:DURHAM, BAYLEIGH (RBT)
Entity type:Individual
Prefix:
First Name:BAYLEIGH
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 FOUNTAINS PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2170
Mailing Address - Country:US
Mailing Address - Phone:618-515-1441
Mailing Address - Fax:
Practice Address - Street 1:343 FOUNTAINS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2170
Practice Address - Country:US
Practice Address - Phone:618-515-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-21-168290106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician