Provider Demographics
NPI:1114147105
Name:BAUMAN, MARK GAVIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:GAVIN
Last Name:BAUMAN
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 1:1591 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-4269
Mailing Address - Country:US
Mailing Address - Phone:720-252-7706
Mailing Address - Fax:
Practice Address - Street 1:7600 E ARAPAHOE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1260
Practice Address - Country:US
Practice Address - Phone:720-252-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional