Provider Demographics
NPI:1710767249
Name:BAILEY, LYDIA (MA, LPC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 KEN PRATT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8998
Mailing Address - Country:US
Mailing Address - Phone:512-554-7325
Mailing Address - Fax:
Practice Address - Street 1:1212 S EMERY ST UNIT I
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8973
Practice Address - Country:US
Practice Address - Phone:512-554-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor