Healthcare Provider Details

I. General information

NPI: 1578189791
Provider Name (Legal Business Name): BAILEY ET AL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 ANCHOR WAY APT 1
FORT COLLINS CO
80525-4716
US

IV. Provider business mailing address

3005 ANCHOR WAY APT 1
FORT COLLINS CO
80525-4716
US

V. Phone/Fax

Practice location:
  • Phone: 720-548-7077
  • Fax:
Mailing address:
  • Phone: 720-548-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF BAILEY
Title or Position: OWNER
Credential: LPC
Phone: 720-548-7077