Provider Demographics
NPI:1417917634
Name:BAUMLER, BRENT (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:BAUMLER
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8669 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-379-0444
Mailing Address - Fax:651-379-0448
Practice Address - Street 1:1500 MCANDREWS RD W
Practice Address - Street 2:SUITE 201
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4432
Practice Address - Country:US
Practice Address - Phone:952-892-8495
Practice Address - Fax:651-379-0448
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC-00139101YP2500X
WI2719-125101YP2500X
MNCC00197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN158J1BAOtherBLUE CROSS/BLUE SHIELD MN