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General NPI Number Information
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NPI Number | 1003217894
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Entity Type | Individual
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Provider Name | IESHAI TAWANDA BAILEY PHD, CMHC, LMHC, CST
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Gender | Female
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 05/07/2023
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Provider Practice Location Address
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Address Line | 401 NW 16TH AVENUE N
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-6250
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Country | US
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Telephone | 904-738-3506
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Fax | 904-204-3291
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Provider Business Mailing Address
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Address Line | 114 LAKE EMERALD DR APT 405
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City | OAKLAND PARK
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State | FL
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Zip | 33309-6250
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Country | US
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Telephone | 754-200-1463
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Fax | 904-204-3291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH14483
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License Number State | FL
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