Provider Demographics
NPI:1447721345
Name:BAILEY, LISA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5100 E HIGHWAY 90 STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2444
Mailing Address - Country:US
Mailing Address - Phone:520-508-9586
Mailing Address - Fax:
Practice Address - Street 1:5100 E HIGHWAY 90 STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2444
Practice Address - Country:US
Practice Address - Phone:520-508-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099260161041C0700X
AZLCSW-222731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09926016OtherLICENSED CLINICAL SOCIAL WORKER
LA13823OtherLOUSIANA STATE BOARD OF SOCIAL WORK EXAMINERS LMSW