Provider Demographics
NPI:1306351440
Name:ANDERSON, BAILEY NOEL WESTERFIELD (LPC)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NOEL WESTERFIELD
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1031
Mailing Address - Country:US
Mailing Address - Phone:719-722-9089
Mailing Address - Fax:719-722-9089
Practice Address - Street 1:1283 KELLY JOHNSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3925
Practice Address - Country:US
Practice Address - Phone:719-722-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACD60772874106S00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician