Provider Demographics
NPI:1275204968
Name:THE BAULCH CENTER, LLC
Entity Type:Organization
Organization Name:THE BAULCH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAULCH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:662-213-5815
Mailing Address - Street 1:425 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-9561
Mailing Address - Country:US
Mailing Address - Phone:662-213-5815
Mailing Address - Fax:
Practice Address - Street 1:7095 WILL ROBBINS HWY
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858-6062
Practice Address - Country:US
Practice Address - Phone:662-213-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty