Healthcare Provider Details

I. General information

NPI: 1962558924
Provider Name (Legal Business Name): AMY MICHELLE BAIBAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N BRIDGE ST
DEWITT MI
48820-8900
US

IV. Provider business mailing address

307 WILSON ST
DEWITT MI
48820-9264
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-2100
  • Fax:
Mailing address:
  • Phone: 517-242-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009975
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: