Provider Demographics
NPI:1205541364
Name:BAILEY, GABRIELLE (MSC, EDS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSC, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155C SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5018
Mailing Address - Country:US
Mailing Address - Phone:954-330-6989
Mailing Address - Fax:
Practice Address - Street 1:9155C SW 23RD ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5018
Practice Address - Country:US
Practice Address - Phone:954-330-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health