Provider Demographics
NPI:1457538803
Name:BAILEY, PAMELA RUTH (LMHC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RUTH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9301
Mailing Address - Country:US
Mailing Address - Phone:407-323-8855
Mailing Address - Fax:321-256-2962
Practice Address - Street 1:4760 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9301
Practice Address - Country:US
Practice Address - Phone:407-323-8855
Practice Address - Fax:321-256-2962
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health