Provider Demographics
NPI:1801640099
Name:BAYLEY PUTMAN COUNSELING LLC
Entity type:Organization
Organization Name:BAYLEY PUTMAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BAYLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-853-4111
Mailing Address - Street 1:1027 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3301
Mailing Address - Country:US
Mailing Address - Phone:503-853-4111
Mailing Address - Fax:
Practice Address - Street 1:1027 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3301
Practice Address - Country:US
Practice Address - Phone:503-853-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)