Healthcare Provider Details

I. General information

NPI: 1821841636
Provider Name (Legal Business Name): BAILLEY OGLES DICKERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W 200 S
FARMINGTON UT
84025-2327
US

IV. Provider business mailing address

76 E RICE LN
FARMINGTON UT
84025-2133
US

V. Phone/Fax

Practice location:
  • Phone: 801-837-8254
  • Fax:
Mailing address:
  • Phone: 801-837-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12883761-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: