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NPI Code Detail

MEDICARE: ROSA BAILEY MA, LPC

MEDICARE:   ROSA  BAILEY  MA, 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
1101YP2500XProfessional Counselor67360TX

General Provider Information

NPI Number : 1407199789
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSA BAILEY MA, LPC
Provider Business Mailing Address
First Line : 305 REGENCY PKWY
Second Line : SUITE 601
City : MANSFIELD
State : TX
Zip : 76063-3794
Country : US
Telephone Number : 682-554-1771
Fax Number : 817-539-0498
Provider Business Practice Location Address
First Line : 305 REGENCY PKWY
Second Line : SUITE 601
City : MANSFIELD
State : TX
Zip : 76063-3794
Country : US
Telephone Number : 682-554-1771
Fax Number : 817-539-0498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2013
Last Update Date : 04/04/2013

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