Provider Demographics
NPI:1184190415
Name:BAUMGARD, JASON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:BAUMGARD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21643 CYPRESS RD APT 14B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3219
Mailing Address - Country:US
Mailing Address - Phone:130-575-3367
Mailing Address - Fax:
Practice Address - Street 1:21643 CYPRESS RD APT 14B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3219
Practice Address - Country:US
Practice Address - Phone:130-575-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty