Provider Demographics
NPI:1659499846
Name:BEAULIEU-BAXTER, ANNE M (LADC LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:M
Last Name:BEAULIEU-BAXTER
Suffix:
Gender:F
Credentials:LADC LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 CHESTER ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05455-5514
Mailing Address - Country:US
Mailing Address - Phone:802-782-3821
Mailing Address - Fax:
Practice Address - Street 1:8 BISHOP ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1639
Practice Address - Country:US
Practice Address - Phone:802-782-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000256101YA0400X
VT0680000702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013445Medicaid