Provider Demographics
NPI:1720188659
Name:BAUM, MELVIN LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:LEE
Last Name:BAUM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2377
Mailing Address - Country:US
Mailing Address - Phone:816-728-0541
Mailing Address - Fax:833-275-1311
Practice Address - Street 1:6408 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2377
Practice Address - Country:US
Practice Address - Phone:816-728-0541
Practice Address - Fax:833-275-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2001022065OtherMISSOURI LPC LICENSE