MEDICARE: JORDAN BAYLESS

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
2	104100000X	Social Worker	0904013677	VA
3	1041C0700X	Clinical Social Worker	0904013677	VA

General Provider Information

NPI Number	:	1912541046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN BAYLESS

Provider Business Mailing Address
First Line	:	423 BRYAN CT
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-2563
Country	:	US
Telephone Number	:	757-952-5849
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ELSINORE PL STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1457
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/25/2022

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Directions to “ JORDAN BAYLESS ” Practice Location

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