MEDICARE: DR. MARY BARROS-BAILEY CRC, NCC, CLCP

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1851567929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BARROS-BAILEY CRC, NCC, CLCP

Provider Business Mailing Address
First Line	:	PO BOX 7511
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83707-1511
Country	:	US
Telephone Number	:	208-229-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	6126 W STATE ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-2741
Country	:	US
Telephone Number	:	208-229-8484
Fax Number	:

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	12/09/2019

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