Provider Demographics
NPI:1801804984
Name:BALDWIN, PEGGY LOUISE (LCPC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:LOUISE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ANNIE GLADE DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-577-6517
Mailing Address - Fax:903-596-8125
Practice Address - Street 1:1455 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-577-6517
Practice Address - Fax:903-596-8125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17637101Y00000X
MTBBH-LCPC-LIC-16607101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127576OtherCHIPS
TX83500LOtherBCBS
TX150784001Medicaid