Healthcare Provider Details

I. General information

NPI: 1639009632
Provider Name (Legal Business Name): BAILEY BOST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 TEAKWOOD LN STE 100
PLANO TX
75075-4407
US

IV. Provider business mailing address

8601 PARK LN APT 224
DALLAS TX
75231-1303
US

V. Phone/Fax

Practice location:
  • Phone: 972-742-0630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: