Provider Demographics
NPI:1689151565
Name:BAUM-MCCONNELL, MARY JO (LPC)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:BAUM-MCCONNELL
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 1:850 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3200
Mailing Address - Country:US
Mailing Address - Phone:814-205-4004
Mailing Address - Fax:814-205-4013
Practice Address - Street 1:313 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1549
Practice Address - Country:US
Practice Address - Phone:814-205-4004
Practice Address - Fax:814-205-4013
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional