Provider Demographics
NPI:1346716040
Name:BAUM, BRITTANNY CAROL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRITTANNY
Middle Name:CAROL
Last Name:BAUM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NEW THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4822
Mailing Address - Country:US
Mailing Address - Phone:304-270-8682
Mailing Address - Fax:
Practice Address - Street 1:1020 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1650
Practice Address - Country:US
Practice Address - Phone:304-886-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVEW64364172A00000X
WV2415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172A00000XOther Service ProvidersDriver