Provider Demographics
NPI:1780857466
Name:DARNELL BAUGHMAN, GLENNA (MS PCC)
Entity type:Individual
Prefix:MS
First Name:GLENNA
Middle Name:
Last Name:DARNELL BAUGHMAN
Suffix:
Gender:F
Credentials:MS PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3475
Mailing Address - Country:US
Mailing Address - Phone:937-684-5273
Mailing Address - Fax:937-256-9876
Practice Address - Street 1:1926 MALCOM DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-3626
Practice Address - Country:US
Practice Address - Phone:937-254-1953
Practice Address - Fax:937-256-9876
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0005416101YM0800X
OHS10071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health