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Individual
MR. RUSSELL TEAL BAILIFF
Active
Individual
MR. RUSSELL TEAL BAILIFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
29264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013EX
BLUE CROSS BLUE SHIELD
TX
05
—
0638405-01
—
TX
05
—
0638405-04
—
TX
Enumeration date
12/01/2006
Last updated
05/25/2016
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