Healthcare Provider Details

I. General information

NPI: 1255464566
Provider Name (Legal Business Name): EMILY ELIZABETH BAILEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. EMILY ELIZABETH MAYNOR

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1115
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

342 BURROW LN
COTTON VALLEY LA
71018-2932
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-4086
  • Fax: 318-623-4087
Mailing address:
  • Phone: 183-510-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6385
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: