Healthcare Provider Details

I. General information

NPI: 1063572089
Provider Name (Legal Business Name): GARY T BAUGHMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BELMONT AVE
YOUNGSTOWN OH
44502-1039
US

IV. Provider business mailing address

17747 CHILLICOTHE RD SUITE 202
CHAGRIN FALLS OH
44023-4739
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-2487
  • Fax: 330-793-2487
Mailing address:
  • Phone: 440-543-8880
  • Fax: 440-543-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0003661
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: