Provider Demographics
NPI:1780388876
Name:ELLIOTT, BAILEY LYNN
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:LYNN
Last Name:ELLIOTT
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 1:27349 JEFFERSON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5612
Mailing Address - Country:US
Mailing Address - Phone:951-466-3032
Mailing Address - Fax:
Practice Address - Street 1:27349 JEFFERSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5612
Practice Address - Country:US
Practice Address - Phone:951-466-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician