Healthcare Provider Details

I. General information

NPI: 1184035891
Provider Name (Legal Business Name): WILLIAM ABRAHAM BAUZO M.DIV., M.A., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 02/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 EAST MAIN STREET SUITE 230
PLAINFIELD IN
46168
US

IV. Provider business mailing address

2680 EAST MAIN STREET SUITE 230
PLAINFIELD IN
46168
US

V. Phone/Fax

Practice location:
  • Phone: 317-551-3374
  • Fax: 888-375-5415
Mailing address:
  • Phone: 317-551-3374
  • Fax: 888-375-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001827A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: