Provider Demographics
NPI:1225780380
Name:GONZALES, BAILEY MICHELLE (CADC, PRSS-S)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:MICHELLE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CADC, PRSS-S
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:MICHELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 E LONG ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2505
Mailing Address - Country:US
Mailing Address - Phone:775-461-0025
Mailing Address - Fax:
Practice Address - Street 1:119 E LONG ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-2505
Practice Address - Country:US
Practice Address - Phone:775-461-0025
Practice Address - Fax:775-461-0512
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07657-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty