Provider Demographics
NPI:1407062532
Name:BAUMGARTNER, DENA DIANE (PHD TEP)
Entity Type:Individual
Prefix:MS
First Name:DENA
Middle Name:DIANE
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:PHD TEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N VINE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1928
Mailing Address - Country:US
Mailing Address - Phone:520-325-6698
Mailing Address - Fax:520-325-9507
Practice Address - Street 1:3601 N VINE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1928
Practice Address - Country:US
Practice Address - Phone:520-325-6698
Practice Address - Fax:520-325-9507
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT 0368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist