Provider Demographics
NPI:1093523516
Name:VEREEN, BAILEY GOMEZ
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:GOMEZ
Last Name:VEREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:JO
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9531 STATE HIGHWAY 151 APT 15207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4475
Mailing Address - Country:US
Mailing Address - Phone:915-255-7566
Mailing Address - Fax:
Practice Address - Street 1:9531 STATE HIGHWAY 151 APT 15207
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4475
Practice Address - Country:US
Practice Address - Phone:915-255-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204186101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health