Provider Demographics
NPI:1336258227
Name:BAUGHMAN, JOHN THOMAS (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3786
Mailing Address - Country:US
Mailing Address - Phone:254-366-0114
Mailing Address - Fax:254-296-0796
Practice Address - Street 1:1000 W STATE HIGHWAY 6
Practice Address - Street 2:SUITE 150
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3786
Practice Address - Country:US
Practice Address - Phone:254-366-0114
Practice Address - Fax:254-296-0796
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12911101YP2500X
TX103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6593LCOtherBLUE CROSS BLUE SHIELD
TX00200XMedicare ID - Type Unspecified