Healthcare Provider Details

I. General information

NPI: 1770314775
Provider Name (Legal Business Name): SARAH BAIRD LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N COLLEGE AVE STE 102
BLOOMINGTON IN
47404-3599
US

IV. Provider business mailing address

2815 E 3RD ST # 1081
BLOOMINGTON IN
47401-5434
US

V. Phone/Fax

Practice location:
  • Phone: 812-269-2634
  • Fax:
Mailing address:
  • Phone: 812-269-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH BAIRD
Title or Position: OWNER
Credential: LMHC, ATR, NCC
Phone: 812-269-2634