Basic Information
Provider Information
NPI: 1003004557
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAILE
FirstName: ERIC
MiddleName: SCOTT
NamePrefix: MR.
NameSuffix:  
Credential: M.DIV., MAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 763 S NEW BALLAS RD
Address2: SUITE 340
City: SAINT LOUIS
State: MO
PostalCode: 631418704
CountryCode: US
TelephoneNumber: 3148722972
FaxNumber: 3148722975
Practice Location
Address1: 763 S NEW BALLAS RD
Address2: SUITE 340
City: SAINT LOUIS
State: MO
PostalCode: 631418704
CountryCode: US
TelephoneNumber: 3148722972
FaxNumber: 3148722975
Other Information
ProviderEnumerationDate: 10/10/2007
LastUpdateDate: 10/10/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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