Provider Demographics
NPI:1952136749
Name:LANDON, BAILEY RHEANN
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:RHEANN
Last Name:LANDON
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 1:903 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3108
Mailing Address - Country:US
Mailing Address - Phone:208-880-7120
Mailing Address - Fax:
Practice Address - Street 1:923 GRANT ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4137
Practice Address - Country:US
Practice Address - Phone:208-585-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health