Provider Demographics
NPI:1073022489
Name:BAILEY-GRAY, WESTLEY (LCSW)
Entity type:Individual
Prefix:
First Name:WESTLEY
Middle Name:
Last Name:BAILEY-GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WESTLEY
Other - Middle Name:BAILEY
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1703 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4619
Mailing Address - Country:US
Mailing Address - Phone:601-421-5999
Mailing Address - Fax:
Practice Address - Street 1:4000 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1894
Practice Address - Country:US
Practice Address - Phone:806-725-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118531041C0700X
LA14522104100000X
LA170371041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1701033Medicaid