Provider Demographics
NPI:1184035891
Name:BAUZO, WILLIAM ABRAHAM (MDIV, MA, LMFT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ABRAHAM
Last Name:BAUZO
Suffix:
Gender:
Credentials:MDIV, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 EAST MAIN STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168
Mailing Address - Country:US
Mailing Address - Phone:317-551-3374
Mailing Address - Fax:888-375-5415
Practice Address - Street 1:2680 EAST MAIN STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-551-3374
Practice Address - Fax:888-375-5415
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001827A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist