Provider Demographics
NPI:1457895922
Name:REIERSON, BAYLIE MCRAE (LMFT)
Entity Type:Individual
Prefix:
First Name:BAYLIE
Middle Name:MCRAE
Last Name:REIERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BAYLIE
Other - Middle Name:M
Other - Last Name:SURJONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:15184 W 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007
Mailing Address - Country:US
Mailing Address - Phone:720-290-8637
Mailing Address - Fax:
Practice Address - Street 1:15184 W 69TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007
Practice Address - Country:US
Practice Address - Phone:720-290-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002217106H00000X
CA112307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist