Provider Demographics
NPI:1952857203
Name:BALUCH, KAREN BAKER (LPCC, LCDC III)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BAKER
Last Name:BALUCH
Suffix:
Gender:F
Credentials:LPCC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2614
Mailing Address - Country:US
Mailing Address - Phone:440-645-1949
Mailing Address - Fax:440-201-6566
Practice Address - Street 1:179 BROAD ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2614
Practice Address - Country:US
Practice Address - Phone:440-488-8646
Practice Address - Fax:440-201-6566
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1200421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199700Medicaid