Active NPI
Kyle Shane Bailey, BA
- Counselor
- Spokane, WA
National Provider Identifier
1720537475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG60713626
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| CG60713626 | WA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New 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.
-
- Community/Behavioral Health Agency
- Spokane, WA
- NPI 1861495327
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.