=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922402528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAUM THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2014
-----------------------------------------------------
Last Update Date | 10/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 S SIERRA BONITA AVE SUITE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-445-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 S SIERRA BONITA AVE SUITE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-445-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MR. STEPHEN ALAN BAUM
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 323-445-4586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LCSW 13512
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------