Provider Demographics
NPI:1730410457
Name:BAYLESS, AUBRIE NICOLE (LPC, DCC)
Entity type:Individual
Prefix:
First Name:AUBRIE
Middle Name:NICOLE
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:LPC, DCC
Other - Prefix:
Other - First Name:AUBRIE
Other - Middle Name:NICOLE
Other - Last Name:HODSON BAYLESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3377 WAGONWHEEL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5810
Mailing Address - Country:US
Mailing Address - Phone:405-245-6218
Mailing Address - Fax:
Practice Address - Street 1:3377 WAGONWHEEL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5810
Practice Address - Country:US
Practice Address - Phone:405-245-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200357230BMedicaid