Provider Demographics
NPI:1184049785
Name:BAUM, JONATHAN (LCSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BAUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:KILA
Mailing Address - State:MT
Mailing Address - Zip Code:59920-0491
Mailing Address - Country:US
Mailing Address - Phone:406-471-2173
Mailing Address - Fax:406-890-6483
Practice Address - Street 1:1077 WHITEFISH STAGE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2735
Practice Address - Country:US
Practice Address - Phone:406-471-2173
Practice Address - Fax:406-890-6483
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT67111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical