Provider Demographics
NPI:1194289470
Name:VALENZUELA, BAILEY (LMSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:ANNE
Other - Last Name:FURTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4702 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7364
Mailing Address - Country:US
Mailing Address - Phone:860-918-8084
Mailing Address - Fax:
Practice Address - Street 1:4312 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3313
Practice Address - Country:US
Practice Address - Phone:254-771-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66055104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker