Provider Demographics
NPI:1619158383
Name:BAUMGARDNER, ROBERT W (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5452
Mailing Address - Country:US
Mailing Address - Phone:707-462-1644
Mailing Address - Fax:707-462-5881
Practice Address - Street 1:205 W CLAY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5452
Practice Address - Country:US
Practice Address - Phone:707-462-1644
Practice Address - Fax:707-462-5881
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist