Provider Demographics
NPI:1043617921
Name:BAUER, PAUL (LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 BLACKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-3205
Mailing Address - Country:US
Mailing Address - Phone:910-409-5238
Mailing Address - Fax:
Practice Address - Street 1:3972 BLACKSMITH ROAD
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-8268
Practice Address - Country:US
Practice Address - Phone:910-409-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9384101YP2500X
PAPC008581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional