Provider Demographics
NPI:1083902415
Name:BAILEY, LAUREL ANN (LMFT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5430
Mailing Address - Country:US
Mailing Address - Phone:253-226-8028
Mailing Address - Fax:
Practice Address - Street 1:816 F ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6121
Practice Address - Country:US
Practice Address - Phone:253-939-2202
Practice Address - Fax:253-735-1894
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60213433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist