Provider Demographics
NPI:1467334037
Name:WHITLEY, BAILEY P
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:P
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:PARKER
Other - Last Name:CABLE-WHITLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32000 RIVERSIDE DR # I-7
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7808
Mailing Address - Country:US
Mailing Address - Phone:951-230-8883
Mailing Address - Fax:
Practice Address - Street 1:27555 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4687
Practice Address - Country:US
Practice Address - Phone:840-260-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician