MEDICARE: JOHN BAILEY IV 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	101YP2500X	Professional Counselor	PC008856	PA

General Provider Information

NPI Number	:	1831553437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BAILEY IV LPC

Provider Business Mailing Address
First Line	:	3300 HENRY AVE STE 113
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	215-895-5588
Fax Number	:	215-895-5658

Provider Business Practice Location Address
First Line	:	3300 HENRY AVE STE 113
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	215-895-5588
Fax Number	:	215-895-5658

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

Provider Enumeration Date	:	04/09/2016
Last Update Date	:	09/03/2021

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