Provider Demographics
NPI:1235701905
Name:BAUMAN PSYCHOTHERAPY COLLABORATIONS, LLC
Entity Type:Organization
Organization Name:BAUMAN PSYCHOTHERAPY COLLABORATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD; LMFT (OWNER)
Authorized Official - Phone:815-245-4825
Mailing Address - Street 1:720 S EASTWOOD DR # 168
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4635
Mailing Address - Country:US
Mailing Address - Phone:815-245-4825
Mailing Address - Fax:
Practice Address - Street 1:457 COVENTRY LN STE 115
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7571
Practice Address - Country:US
Practice Address - Phone:815-245-4825
Practice Address - Fax:815-596-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health