Provider Demographics
NPI:1598311847
Name:BAUER, JUDY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:BAUER
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 1:8780 BIG BEND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3774
Mailing Address - Country:US
Mailing Address - Phone:314-620-0304
Mailing Address - Fax:
Practice Address - Street 1:8780 BIG BEND BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3774
Practice Address - Country:US
Practice Address - Phone:314-620-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional