Provider Demographics
NPI:1275970998
Name:BAUTZ, ANDREW (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BAUTZ
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:NORTH WEBSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46555-0751
Mailing Address - Country:US
Mailing Address - Phone:574-834-1393
Mailing Address - Fax:574-834-1205
Practice Address - Street 1:225 NORTH MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTH WEBSTER
Practice Address - State:IN
Practice Address - Zip Code:46555
Practice Address - Country:US
Practice Address - Phone:574-834-1393
Practice Address - Fax:574-834-1205
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001966A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist