MEDICARE: MR. JAMES M BAILEY JR. LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	146	LA

General Provider Information

NPI Number	:	1073534657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES M BAILEY JR. LPC

Provider Business Mailing Address
First Line	:	735 LECOMPTE ST
Second Line	:
City	:	DERIDDER
State	:	LA
Zip	:	70634-3340
Country	:	US
Telephone Number	:	337-401-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 LECOMPTE ST
Second Line	:
City	:	DERIDDER
State	:	LA
Zip	:	70634-3340
Country	:	US
Telephone Number	:	337-401-6010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/10/2008

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