Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00107933 |
NPI | 1124315478 |
---|---|
Provider Name | Mr. Brent Stephen Bailey |
First Address | Bangor, ME 04401-5208 |
Second Address | Bangor, ME 04401-5208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 07/07/2011 |