Individual provider Active NPI

Kyle Shane Bailey, BA

  • Counselor
  • Spokane, WA
National Provider Identifier
1720537475
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
CG60713626 Issued in WA
Practice address
5901 N Lidgerwood St Ste 115
Spokane, WA 99208-1122
Phone
(509) 838-4651
NPI assigned
Sep 22, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Counselor 101Y00000X CG60713626 WA Primary

Addresses

Primary practice location

5901 N Lidgerwood St Ste 115
Spokane, WA 99208-1122

Mailing address

107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651

Other practice location 1

1003 7th Ave
Kirkland, WA 98033-5779
Phone (425) 658-3016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Arts

State licenses

LicenseStateTypeSpecialty
CG60713626WAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Behavioral Health Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1720537475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N LIDGERWOOD ST STE 115",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081122",
            "telephone_number": "509-838-4651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1003 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980335779",
            "country_code": "US",
            "telephone_number": "425-658-3016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "KYLE",
        "middle_name": "SHANE",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-22",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG60713626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.