Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | E-0500778 | OH |
Y | 101YM0800X | Mental Health Counselor | E-0500778 | OH |
N | 101YP1600X | Pastoral Counselor | E0500778 | OH |
N | 101YP2500X | Professional Counselor | E0500778 | OH |
NPI | 1073841847 |
---|---|
Provider Name | Ms. Iris Lynn Bailey |
First Address | Beachwood, OH 44122-5540 |
Second Address | Beachwood, OH 44122-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2009 |
Last Update Date | 21/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055659 | (05) | OH |