Provider Demographics
NPI:1912781733
Name:BAILEY, JOSEPH (LAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VAN CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5273
Mailing Address - Country:US
Mailing Address - Phone:501-263-1576
Mailing Address - Fax:
Practice Address - Street 1:2 VAN CIR STE 3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5273
Practice Address - Country:US
Practice Address - Phone:501-263-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2308001101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor