Healthcare Provider Details

I. General information

NPI: 1871619494
Provider Name (Legal Business Name): ERIC C BAILLY LPC, CAC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BROADWAY
DENVER CO
80203-3421
US

IV. Provider business mailing address

2585 HOLLY ST
DENVER CO
80207-3227
US

V. Phone/Fax

Practice location:
  • Phone: 303-367-2900
  • Fax:
Mailing address:
  • Phone: 720-225-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number4447
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2284
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: