Provider Demographics
NPI:1881360212
Name:BAILEY, KIRSTIE (LPC)
Entity type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 S 59TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4294
Mailing Address - Country:US
Mailing Address - Phone:479-366-6455
Mailing Address - Fax:
Practice Address - Street 1:1400 SW SUSANA ST STE 12
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-7877
Practice Address - Country:US
Practice Address - Phone:479-203-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2412024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional