Healthcare Provider Details

I. General information

NPI: 1346442258
Provider Name (Legal Business Name): JOSEPH R BAUNOCH SR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S MAIN ST
YALE MI
48097-3316
US

IV. Provider business mailing address

2894 W RICK DR
PORT HURON MI
48060-6533
US

V. Phone/Fax

Practice location:
  • Phone: 810-841-4745
  • Fax:
Mailing address:
  • Phone: 810-841-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39000055A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000055A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: