Provider Demographics
NPI:1164920278
Name:ALEXIS SMITH-BAUMANN, PSY.D., CLINICAL PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:ALEXIS SMITH-BAUMANN, PSY.D., CLINICAL PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:925-324-1593
Mailing Address - Street 1:1855 SAN MIGUEL DR STE 23
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5290
Mailing Address - Country:US
Mailing Address - Phone:925-324-1593
Mailing Address - Fax:
Practice Address - Street 1:1855 SAN MIGUEL DR STE 23
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5290
Practice Address - Country:US
Practice Address - Phone:925-324-1593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28050261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)