MEDICARE: ALCIANIECE T BAILEY M.A.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1902170053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALCIANIECE T BAILEY M.A.

Provider Business Mailing Address
First Line	:	1454 W 94TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3905
Country	:	US
Telephone Number	:	310-227-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 W 94TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3905
Country	:	US
Telephone Number	:	310-227-4440
Fax Number	:

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

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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