Provider Demographics
NPI:1235453523
Name:BAUN, STACEY L (LPC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:BAUN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JAVIT CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2409
Mailing Address - Country:US
Mailing Address - Phone:330-793-2487
Mailing Address - Fax:330-793-4559
Practice Address - Street 1:5399 LAUBY RD STE 130
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1554
Practice Address - Country:US
Practice Address - Phone:330-497-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0800511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional