Provider Demographics
NPI:1154770642
Name:BAILEY, HAILEY M (LPC INTERN/QMHP)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPC INTERN/QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:971-386-2278
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:1776 SW MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1715
Practice Address - Country:US
Practice Address - Phone:503-224-1044
Practice Address - Fax:503-621-2235
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500709746Medicaid