Healthcare Provider Details

I. General information

NPI: 1851792709
Provider Name (Legal Business Name): CRYSTAL MARIE BAUGH MH 13505
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 US HIGHWAY 27 S
SEBRING FL
33876-5711
US

IV. Provider business mailing address

107 MEDICAL CENTER AVE
SEBRING FL
33870-5423
US

V. Phone/Fax

Practice location:
  • Phone: 863-991-3232
  • Fax: 866-634-3605
Mailing address:
  • Phone: 863-382-9280
  • Fax: 863-382-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: