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General NPI Number Information
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NPI Number | 1982140307
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Entity Type | Organization
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Legal Business Name | NICOLLE M BAUER LMHC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 2200 N PONCE DE LEON BLVD STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2600
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Country | US
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Telephone | 904-501-8270
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Fax | 904-819-5330
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Provider Business Mailing Address
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Address Line | 2200 N PONCE DE LEON BLVD STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2600
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Country | US
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Telephone | 904-501-8270
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Fax | 904-819-5330
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Authorized Official
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Title or Position | OWNER
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Name | NICOLLE M BAUER
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Credential | LMHC
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Telephone | 904-501-8270
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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 | MH6243
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License Number State | FL
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