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General NPI Number Information
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NPI Number | 1902787450
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Entity Type | Individual
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Provider Name | TIMOTHY BAILEY
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Gender | Male
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 121 S LINCOLNWAY STE 104
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City | NORTH AURORA
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State | IL
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Zip | 60542-5117
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Country | US
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Telephone | 630-787-7673
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CHAPIN WAY
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City | OSWEGO
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State | IL
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Zip | 60543-4009
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Country | US
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Telephone | 901-489-8515
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Fax |
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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 |
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License Number State | IL
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