Provider Demographics
NPI:1982996757
Name:BAILEY, LISA MARIE (LPC-S)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BURROWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-1978
Mailing Address - Country:US
Mailing Address - Phone:936-577-1186
Mailing Address - Fax:
Practice Address - Street 1:9040 FM 1617
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7525
Practice Address - Country:US
Practice Address - Phone:936-577-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional