MEDICARE: BAILEY WILLIAMS MS, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	2013036484	MO
2	101YP2500X	Professional Counselor	2013036484	MO

General Provider Information

NPI Number	:	1205264710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY WILLIAMS MS, LPC

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 W US HIGHWAY 40
Second Line	:
City	:	ODESSA
State	:	MO
Zip	:	64076-9612
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

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

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	03/04/2021

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