Healthcare Provider Details

I. General information

NPI: 1992313142
Provider Name (Legal Business Name): RICHARD L BALDWIN MA/LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6564 GRAND RIVER RD.
RIVES JUNCTION MI
49277
US

IV. Provider business mailing address

6564 GRAND RIVER RD.
RIVES JUNCTION MI
49277
US

V. Phone/Fax

Practice location:
  • Phone: 517-569-8467
  • Fax:
Mailing address:
  • Phone: 517-569-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401004088
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401004088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: