Provider Demographics
NPI:1033455662
Name:BAUGESS, TYNA L (CAP)
Entity Type:Individual
Prefix:
First Name:TYNA
Middle Name:L
Last Name:BAUGESS
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 SOPHIAS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6211
Mailing Address - Country:US
Mailing Address - Phone:614-271-3474
Mailing Address - Fax:
Practice Address - Street 1:3157 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2940
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:407-261-0523
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5629101Y00000X
OH081148101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033455662Medicaid