Provider Demographics
NPI:1124123831
Name:BAILEY, BRIAN PATRICK (MA, LPC LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MA, LPC LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8475
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-0475
Mailing Address - Country:US
Mailing Address - Phone:304-529-7686
Mailing Address - Fax:304-529-7686
Practice Address - Street 1:228 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1135
Practice Address - Country:US
Practice Address - Phone:304-529-7686
Practice Address - Fax:304-529-7686
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163319000Medicaid