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General NPI Number Information
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NPI Number | 1982206082
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Entity Type | Organization
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Legal Business Name | LAURIE BALTZ COUNSELING, LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 8 EAGLE CTR STE 15
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City | BELLEVILLE
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State | IL
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Zip | 62269-1947
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Country | US
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Telephone | 618-567-3693
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 ROAN HILL DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-6918
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Country | US
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Telephone | 618-567-3693
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | LAURIE BALTZ
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Credential |
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Telephone | 618-567-3693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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