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General NPI Number Information
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NPI Number | 1598273955
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Entity Type | Individual
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Provider Name | RACHAEL ANN BAUSE LPC
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 143 GOUGLER AVE
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City | KENT
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State | OH
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Zip | 44240-2401
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Country | US
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Telephone | 330-677-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 6605 STATE ROUTE 5 LOT 4
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City | RAVENNA
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State | OH
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Zip | 44266-9613
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Country | US
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Telephone | 330-257-3696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.1700489
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License Number State | OH
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