Provider Demographics
NPI:1720487283
Name:BAILEY, PATRICIA ANNETTE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 MCPHERSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-751-2524
Mailing Address - Fax:541-751-2661
Practice Address - Street 1:281 LACLAIR ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2988
Practice Address - Country:US
Practice Address - Phone:541-266-6710
Practice Address - Fax:541-266-6800
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA2526101YM0800X
ORL65281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health