Healthcare Provider Details

I. General information

NPI: 1598460610
Provider Name (Legal Business Name): KATHLEEN SULLIVAN BAUM MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32801 HWY 441 NO. #185
OKEECHOBEE FL
34972
US

IV. Provider business mailing address

32801 HWY 441 NO. #185
OKEECHOBEE FL
34972
US

V. Phone/Fax

Practice location:
  • Phone: 772-528-3488
  • Fax:
Mailing address:
  • Phone: 772-528-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: