Provider Demographics
NPI:1598070393
Name:BAUM, KOEN KERI ARION (LMFT)
Entity Type:Individual
Prefix:
First Name:KOEN KERI
Middle Name:ARION
Last Name:BAUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KERI KOEN
Other - Middle Name:ARION
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:3896 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114
Mailing Address - Country:US
Mailing Address - Phone:415-646-0565
Mailing Address - Fax:
Practice Address - Street 1:3896 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:415-646-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT#38312102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst