Healthcare Provider Details

I. General information

NPI: 1629592076
Provider Name (Legal Business Name): LEE JAMES BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S FRETZ AVE STE C
EDMOND OK
73003-5570
US

IV. Provider business mailing address

617 NW 121ST ST
OKLAHOMA CITY OK
73114-8308
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-9808
  • Fax:
Mailing address:
  • Phone: 405-503-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: