Provider Demographics
NPI:1679071344
Name:BAUMGARDNER, MICHELLE L (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S KENTUCKY ST STE C245
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2293
Mailing Address - Country:US
Mailing Address - Phone:806-676-0212
Mailing Address - Fax:
Practice Address - Street 1:1616 S KENTUCKY ST STE C245
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2293
Practice Address - Country:US
Practice Address - Phone:806-676-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional