Provider Demographics
NPI:1871619494
Name:BAILLY, ERIC C (LPC, CAC III)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:BAILLY
Suffix:
Gender:M
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3227
Mailing Address - Country:US
Mailing Address - Phone:720-225-6158
Mailing Address - Fax:
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3421
Practice Address - Country:US
Practice Address - Phone:303-367-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44472084A0401X
CO2284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAB30627OtherEMPLOYEE ID