Provider Demographics
NPI:1861276503
Name:BAILEY, LISA M (LLPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6963 W KL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8043
Mailing Address - Country:US
Mailing Address - Phone:269-459-9790
Mailing Address - Fax:269-459-9791
Practice Address - Street 1:6963 W KL AVE STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8043
Practice Address - Country:US
Practice Address - Phone:269-459-9790
Practice Address - Fax:269-459-9791
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022852101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor