Provider Demographics
NPI:1144949736
Name:ROSS, BAILEY JANE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:JANE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 S 194TH ST W
Mailing Address - Street 2:
Mailing Address - City:COUNCIL HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74428-5100
Mailing Address - Country:US
Mailing Address - Phone:918-207-9894
Mailing Address - Fax:
Practice Address - Street 1:11524 S 194TH ST W
Practice Address - Street 2:
Practice Address - City:COUNCIL HILL
Practice Address - State:OK
Practice Address - Zip Code:74428-5100
Practice Address - Country:US
Practice Address - Phone:918-207-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional