MEDICARE: JONATHON C BAILLIE MS 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	101Y00000X	Counselor	677	WY
2	101Y00000X	Counselor	1392	WY

General Provider Information

NPI Number	:	1952662751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON C BAILLIE MS LPC

Provider Business Mailing Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	307-734-0017

Provider Business Practice Location Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	307-734-0017

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	01/18/2022

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