Provider Demographics
NPI:1518789171
Name:BAILEY AMIS COUNSELING
Entity type:Organization
Organization Name:BAILEY AMIS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:918-230-5189
Mailing Address - Street 1:2249 W ADDISON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5078
Mailing Address - Country:US
Mailing Address - Phone:918-230-5189
Mailing Address - Fax:
Practice Address - Street 1:2249 W ADDISON ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5078
Practice Address - Country:US
Practice Address - Phone:918-230-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty