Healthcare Provider Details

I. General information

NPI: 1861340580
Provider Name (Legal Business Name): KELLYMARIE SHEPHERD BAUER MSW, ACSW, RAC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 G ST STE E1
MERCED CA
95340-2953
US

IV. Provider business mailing address

PO BOX 41
DENAIR CA
95316-0041
US

V. Phone/Fax

Practice location:
  • Phone: 209-259-3851
  • Fax:
Mailing address:
  • Phone: 209-777-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number128763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: