Provider Demographics
NPI:1972666261
Name:BAUGH, LANCE J (PHD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:J
Last Name:BAUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CRESTWOOD EXECUTIVE CTR
Mailing Address - Street 2:SUITE519
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1945
Mailing Address - Country:US
Mailing Address - Phone:314-965-2415
Mailing Address - Fax:314-845-3443
Practice Address - Street 1:50 CRESTWOOD EXECUTIVE CTR
Practice Address - Street 2:SUITE519
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1945
Practice Address - Country:US
Practice Address - Phone:314-965-2415
Practice Address - Fax:314-845-3443
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical