Provider Demographics
NPI:1235624495
Name:BAILEY, JACOB W (LPC, CAS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LPC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42934 PEARSON RANCH LOOP
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4458
Mailing Address - Country:US
Mailing Address - Phone:801-512-5372
Mailing Address - Fax:
Practice Address - Street 1:42934 PEARSON RANCH LOOP
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-4458
Practice Address - Country:US
Practice Address - Phone:801-512-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health