=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205655420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON DANIEL BAHLMAN-CLIPPARD LLPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2024
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11111 HALL RD STE 300
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48317-5726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-887-3153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2904 RAVINE DR APT 108
-----------------------------------------------------
City | LAKE ORION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48360-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-322-0790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451023970
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------