Healthcare Provider Details

I. General information

NPI: 1285456152
Provider Name (Legal Business Name): BAILEY PREIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12166 OLD BIG BEND RD STE 204
SAINT LOUIS MO
63122-6836
US

IV. Provider business mailing address

6201 ARTHUR AVE
SAINT LOUIS MO
63139-2016
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-8888
  • Fax:
Mailing address:
  • Phone: 704-962-9232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024034526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: