=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942210901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOE BAILEY DUKE M.ED, LPC-S, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 01/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3709 22ND PLACE SUITE C
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-795-3911
-----------------------------------------------------
Fax | 806-795-2315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3114 39TH STREET
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-790-4472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------