| Doctor Name: | MR. RUSSELL TEAL BAILIFF |
| NPI Number: | 1831267699 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 29264 |
| Business Practice Address: | 716 Linus Ln Lindale, TX - 757716626 |
| Business Phone Number: | 9033127246 |
| Business Fax Number: | |
| Mailing Address: | Po Box 726, LINDALE |
| State: | TX |
| Postal Code: | 757710726 |
| Phone Number: | 9033127246 |
| Fax Number: | |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 05/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 29264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |