Healthcare Provider Details

I. General information

NPI: 1184945677
Provider Name (Legal Business Name): DAN JAMES BAYLY LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S ASBURY ST STE 4
MOSCOW ID
83843-2243
US

IV. Provider business mailing address

325 W 3RD ST
MOSCOW ID
83843-2204
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2566
  • Fax: 888-972-5312
Mailing address:
  • Phone: 208-882-2566
  • Fax: 888-972-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-4442
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC-4868
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC-4442
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-4442
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-4868
License Number StateID
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-4868
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: