Provider Demographics
NPI:1386869402
Name:BAILIS, GALE ELAINE (LPC)
Entity type:Individual
Prefix:MISS
First Name:GALE
Middle Name:ELAINE
Last Name:BAILIS
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 1:610 LEECREST ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2032
Mailing Address - Country:US
Mailing Address - Phone:330-832-9619
Mailing Address - Fax:
Practice Address - Street 1:4801 DRESSLER RD NW
Practice Address - Street 2:SUITE130
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3667
Practice Address - Country:US
Practice Address - Phone:330-649-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC5874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health