Healthcare Provider Details

I. General information

NPI: 1417688433
Provider Name (Legal Business Name): BAILEY COGGER AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 INDUSTRIAL ST
REDDING CA
96002-0734
US

IV. Provider business mailing address

3716 VINEWOOD DR
ANDERSON CA
96007-4720
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-9957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT133107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: