Provider Demographics
NPI:1164941449
Name:BAUMRUCKER, DAVID CRAIG (MA, LPCC, NCC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CRAIG
Last Name:BAUMRUCKER
Suffix:
Gender:M
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 80TH ST S STE 210
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3063
Mailing Address - Country:US
Mailing Address - Phone:651-797-3171
Mailing Address - Fax:
Practice Address - Street 1:7501 80TH ST S STE 210
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3063
Practice Address - Country:US
Practice Address - Phone:651-797-3171
Practice Address - Fax:651-925-0604
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02165101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty