Provider Demographics
NPI:1982206082
Name:LAURIE BALTZ COUNSELING, LLC
Entity Type:Organization
Organization Name:LAURIE BALTZ COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-567-3693
Mailing Address - Street 1:3208 ROAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6918
Mailing Address - Country:US
Mailing Address - Phone:618-567-3693
Mailing Address - Fax:
Practice Address - Street 1:8 EAGLE CTR STE 15
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62269-1947
Practice Address - Country:US
Practice Address - Phone:618-567-3693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134665110OtherNPI