Healthcare Provider Details

I. General information

NPI: 1063127157
Provider Name (Legal Business Name): ANDREW BAILEY CT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

IV. Provider business mailing address

1404 PARK AVE W STE 2
ONTARIO OH
44906-2719
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-5993
  • Fax: 567-560-5483
Mailing address:
  • Phone: 419-522-6191
  • Fax: 419-526-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: