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General NPI Number Information
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NPI Number | 1518789171
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Entity Type | Organization
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Legal Business Name | BAILEY AMIS COUNSELING
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 2249 W ADDISON ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60618-5078
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Country | US
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Telephone | 918-230-5189
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Fax |
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Provider Business Mailing Address
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Address Line | 2249 W ADDISON ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60618-5078
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Country | US
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Telephone | 918-230-5189
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | BAILEY AMIS
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Credential | LCPC
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Telephone | 918-230-5189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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