Healthcare Provider Details

I. General information

NPI: 1245937952
Provider Name (Legal Business Name): MARTHA E BAILEY MS, LIAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E COTTONWOOD LN
CASA GRANDE AZ
85122-2500
US

IV. Provider business mailing address

408 E SETTLERS TRL
CASA GRANDE AZ
85122-8792
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax:
Mailing address:
  • Phone: 480-983-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIAC-155357
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: