Healthcare Provider Details

I. General information

NPI: 1740108208
Provider Name (Legal Business Name): MR. CALEB MICAH BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 18TH ST
NICEVILLE FL
32578-3353
US

IV. Provider business mailing address

1603 18TH ST
NICEVILLE FL
32578-3353
US

V. Phone/Fax

Practice location:
  • Phone: 850-974-6047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM28020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: