Provider Demographics
NPI:1649677386
Name:BAILEY, IAN PAULL (LCPC)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:PAULL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 PEBBLE BROOKE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3854
Mailing Address - Country:US
Mailing Address - Phone:206-395-5583
Mailing Address - Fax:443-898-9882
Practice Address - Street 1:6517 PEBBLE BROOKE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3854
Practice Address - Country:US
Practice Address - Phone:206-395-5583
Practice Address - Fax:410-695-3511
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional