Healthcare Provider Details

I. General information

NPI: 1508613555
Provider Name (Legal Business Name): BAILEE YORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W CHARLESTON BLVD
LAS VEGAS NV
89102-2205
US

IV. Provider business mailing address

4320 FENTON LN
N LAS VEGAS NV
89032-0143
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-7746
  • Fax:
Mailing address:
  • Phone: 702-588-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02621-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: