Provider Demographics
NPI:1366422206
Name:BAILLY, REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BAILLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-0232
Mailing Address - Country:US
Mailing Address - Phone:307-634-5114
Mailing Address - Fax:307-634-0588
Practice Address - Street 1:1616 WARREN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4555
Practice Address - Country:US
Practice Address - Phone:307-634-5114
Practice Address - Fax:307-634-0588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY256103TC0700X
CO1972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical