Provider Demographics
NPI:1174120588
Name:LASSITER, BAILEY NOEL
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NOEL
Last Name:LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 S GLASSELL ST APT B
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1967
Mailing Address - Country:US
Mailing Address - Phone:949-769-0714
Mailing Address - Fax:
Practice Address - Street 1:353 S GLASSELL ST APT B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1967
Practice Address - Country:US
Practice Address - Phone:949-414-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist