Provider Demographics
NPI:1316322811
Name:BAILEY AND ASSOCIATES, COUNSELING & PSYCHOTHERAPY
Entity type:Organization
Organization Name:BAILEY AND ASSOCIATES, COUNSELING & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-623-3260
Mailing Address - Street 1:2124 W POTOMAC AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2302 W NORTH AVE
Practice Address - Street 2:#1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6260
Practice Address - Country:US
Practice Address - Phone:312-623-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007162101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty