Travis Lee Bailey, CADC-II, ICADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Auburn, CA
NPI 1497939862 · NPPES record last updated Dec 17, 2019
Key facts
- NPI
- 1497939862
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- A01990315 (CA)
- Practice address
- 12125 Shale Ridge LN
Auburn, CA 95602-8880 - Phone
- (530) 855-1917
- Fax
- (530) 885-1169
- NPI assigned
- Dec 20, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A01990315 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Granite Wellness Centers | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | A01990315 | CA | Yes |
Addresses
Primary practice location
12125 Shale Ridge LN
Auburn, CA 95602-8880
Mailing address
12125 Shale Ridge LN
Auburn, CA 95602-8880
Phone (530) 855-1917
Other providers in Auburn, CA
- Lyn Swe Aye
- Gwen Hyatt Ayliffe
- John Frank Ayres
- Matthew Ayres
- Chelsea Azarcon
- Brittney Baisden
- John H Baker Jr.
- Kameron Baker
- Yvonne Baker
- Nicola Baldwin
All providers in Auburn, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.