Provider Demographics
NPI:1740963909
Name:BAILEY, BRIAN R (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:BAILEY
Suffix:
Gender:
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7504
Mailing Address - Country:US
Mailing Address - Phone:843-267-4087
Mailing Address - Fax:
Practice Address - Street 1:110 YE OLDE KINGS HWY
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4384
Practice Address - Country:US
Practice Address - Phone:843-663-0770
Practice Address - Fax:843-663-0772
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health