Provider Demographics
NPI:1740871839
Name:BAILEY, BRENT L JR (APCC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:L
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 50TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3378
Mailing Address - Country:US
Mailing Address - Phone:752-678-5344
Mailing Address - Fax:
Practice Address - Street 1:4437 50TH ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3378
Practice Address - Country:US
Practice Address - Phone:752-678-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11492101YA0400X
CA15436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)