MEDICARE: ACIENA BAILEY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1402785081	OTHER	NV	NEVADA DRIVER'S LICENSE

General Provider Information

NPI Number	:	1154798080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACIENA BAILEY

Provider Business Mailing Address
First Line	:	9313 CHILLY POND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6907
Country	:	US
Telephone Number	:	702-937-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	9313 CHILLY POND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6907
Country	:	US
Telephone Number	:	702-937-9106
Fax Number	:

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

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	08/26/2015

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Directions to “ ACIENA BAILEY ” Practice Location

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