Healthcare Provider Details

I. General information

NPI: 1932569241
Provider Name (Legal Business Name): CARL BAUMAN II LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOOMER BAUMAN LPC

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6299 CAMP RD
WEST SALEM OH
44287-9032
US

IV. Provider business mailing address

6299 CAMP RD
WEST SALEM OH
44287-9032
US

V. Phone/Fax

Practice location:
  • Phone: 419-869-4069
  • Fax:
Mailing address:
  • Phone: 419-869-4069
  • Fax: 540-949-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007683
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006335
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: