Healthcare Provider Details

I. General information

NPI: 1639628597
Provider Name (Legal Business Name): BAILEY NEWELL MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 RUTH ST N STE 101
SAINT PAUL MN
55119-4409
US

IV. Provider business mailing address

245 RUTH ST N STE 101
SAINT PAUL MN
55119-4409
US

V. Phone/Fax

Practice location:
  • Phone: 651-955-4633
  • Fax:
Mailing address:
  • Phone: 651-955-4633
  • Fax: 651-440-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4153
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: